Time filter

Source Type

Artigues-près-Bordeaux, France

Crouzet S.,Edouard Herriot Hospital | Crouzet S.,University of Lyon | Rebillard X.,Beau Soleil Clinic | Chevallier D.,Pasteur Hospital | And 7 more authors.
European Urology | Year: 2010

Background: High-intensity focused ultrasound (HIFU) is an emerging treatment for select patients with localized prostate cancer (PCa). Objectives: To report the oncologic outcome of HIFU as a primary care option for localized prostate cancer from a multicenter database. Design, setting, and participants: Patients with localized PCa treated with curative intent and presenting at least a 2-yr follow-up from February 1993 were considered in this study. Previously irradiated patients were excluded from this analysis. In case of any residual or recurrent PCa, patients were systematically offered a second session. Kaplan-Meier analysis was performed to determine disease-free survival rates (DFSR). Measurements: Prostate-specific antigen (PSA), clinical stage, and pathologic results were measured pre- and post-HIFU. Results and limitations: A total of 803 patients from six urologic departments met the inclusion criteria. Stratification according to d'Amico's risk group was low, intermediate, and high in 40.2%, 46.3%, and 13.5% of patients, respectively. Mean follow-up was 42 ± 33 mo. Mean PSA nadir was 1.0 ± 2.8 ng/ml with 54.3% reaching a nadir of ≤0.3 ng/ml. Control biopsies were negative in 85% of cases. The overall and cancer-specific survival rates at 8 yr were 89% and 99%, respectively. The metastasis-free survival rate at 8 yr was 97%. Initial PSA value and Gleason score value significantly influence the DFSR. The 5- and 7-yr biochemical-free survival rates (Phoenix criteria) were 83-75%, 72-63%, and 68-62% (p = 0.03) and the additional treatment-free survival rates were 84-79%, 68-61%, and 52-54% (p < 0.001) for low-, intermediate-, and high-risk patients, respectively. PSA nadir was a major predictive factor for HIFU success: negative biopsies, stable PSA, and no additional therapy. Conclusions: Local control and DFSR achieved with HIFU were similar to those expected with conformal external-beam radiation therapy (EBRT). The excellent cancer-specific survival rate is also explained by the possibility to repeat HIFU and use salvage EBRT. © 2010 European Association of Urology. Source

McClenaghan F.,Royal London Hospital | Fell M.,Royal Infirmary | Martin D.,Pellegrin Hospital | Smith G.,St. Georges Hospital | McGurk M.,Guys Hospital
International Journal of Oral and Maxillofacial Surgery | Year: 2013

Surgical missions to the developing world have been criticized for their lack of outcome analysis. Reported studies indicate a high rate of postoperative complications. An integrated pathway developed for surgical missions and a report of its performance in action is presented herein. Patients were optimized for surgery by a medical team from the UK for a minimum of 14 days preoperatively. They were then transferred to hospital for surgery and returned when stable. At the completion of the mission a junior doctor remained behind for 3 weeks to chart the patients' progress. Thirty case patients were treated over a 2-week period. The complication rate at 3 weeks postoperatively was 7/30. Twenty-two operations were classified as complex (over 1 h with more than one flap) and eight as simple (under 1 h with minimal flaps). Of those undergoing the simple operations, 2/8 encountered complications at an average of 5 days postoperatively (range 3-7 days). Many medical teams depart in an elevated atmosphere of accomplishment, which without an outcome analysis gives a false impression of their positive impact. Outcome analysis is essential to honestly appraise the effect of surgical missions. © 2013 International Association of Oral and Maxillofacial Surgeons. Source

Bourghli A.,Pellegrin Hospital | Fabre A.,Richelieu Clinic
Orthopaedics and Traumatology: Surgery and Research | Year: 2012

Fractures of the medial end of the clavicle are the least common type of clavicle fracture. We report a 29-year-old military parachutist who presented with medial end clavicle fracture after a bad landing. He was first treated non-operatively in a tertiary center and was then referred to our center by his general practitioner. Surgery was indicated since the fracture was displaced and the patient needed anatomical reconstruction to promote rapid bone healing and a prompt return to work. The medial fragment being comminuted, K-wires were used for internal fixation instead of a plate. The two K-wires were bent 180° to avoid risk of migration and were removed 3 months after surgery when the patient had begun to perform all activities without pain. Aggressive treatment is recommended for medial end clavicle fracture in case of displacement and facilitates rapid functional recovery, notably in patients with considerable clavicular demand. © 2012 Elsevier Masson SAS. Source

Farid K.,Hotel Dieu Hospital | Caillat-Vigneron N.,Hotel Dieu Hospital | Caillat-Vigneron N.,University of Paris Descartes | Sibon I.,Pellegrin Hospital
Journal of Computer Assisted Tomography | Year: 2011

Cerebral blood flow assessment performed by single-photon emission computed tomography (SPECT) of the brain is used to detect early neuronal dysfunction associated with degenerative dementia. Patterns of perfusion abnormalities are different across dementia syndromes. These differences could be used for differential diagnoses and early detection of amnesic mild cognitive impairment in patients with a high risk of conversion to Alzheimer disease. This paper aimed to summarize the expected benefits of single-photon emission computed tomography of the brain in the exploration of degenerative dementias. Copyright © 2011 by Lippincott Williams & Wilkins. Source

Bedi R.,Iris Advanced Eye Center | Touboul D.,Pellegrin Hospital | Pinsard L.,Pellegrin Hospital | Colin J.,Pellegrin Hospital | And 2 more authors.
Journal of Refractive Surgery | Year: 2012

PURPOSE: To evaluate the long-term rate of progression of keratoconus in eyes implanted with Intacs (Addition Technology Inc) at 5-year follow-up. METHODS: Data of 105 eyes from 85 patients who had undergone consecutive Intacs implantation between January 2001 and December 2005 were studied retrospectively for progression of keratoconus. Progression of keratoconus was defined as an increase in steep keratometry (K) of ≥1.00 diopter (D) over 4 years between 1- and 5-year follow-up. All eyes were categorized into three subgroups: eyes with documented preoperative progression (change in steep K ≥1.00 D over 12 months preoperatively), eyes with documented absence of preoperative progression, and eyes with no record of preoperative progression. RESULTS: Ninety-two eyes were available for analysis. Overall, 91.3% (84/92) of eyes demonstrated no progression between 1- and 5-year follow-up. In the sub-group analysis, 92.9% (52/56) of eyes with documented preoperative progression demonstrated no progression. Additionally, no statistically significant differences were noted in mean steep, flat, and average keratometry; manifest refraction spherical equivalent; and uncorrected and corrected distance visual acuity (P>.05) between 1- and 5-year follow-up. CONCLUSIONS: Results of our study demonstrate the long-term stability of refractive and topographic outcomes following Intacs implantation in eyes with keratoconus. The finding that 92.9% of eyes with progressive keratoconus did not progress postoperatively indicates that Intacs implantation may be a potential therapeutic option to halt progressive keratoconus. Copyright © SLACK Incorporated. Source

Discover hidden collaborations