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Burger M.,University of Regensburg | Thiounn N.,Hopital Necker Pole Adulte | Denzinger S.,University of Regensburg | Kondas J.,Urologiai Sebeszeti Osztaly | And 16 more authors.
Journal of Translational Medicine | Year: 2010

Introduction: While adjuvant immunotherapy with Bacille Calmette Guérin (BCG) is effective in non-muscle-invasive bladder cancer (BC), adverse events (AEs) are considerable. Monocyte-derived activated killer cells (MAK) are discussed as essential in antitumoural immunoresponse, but their application may imply risks. The present trial compared autologous intravesical macrophage cell therapy (BEXIDEM®) to BCG in patients after transurethral resection (TURB) of BC.Materials and methods: This open-label trial included 137 eligible patients with TaG1-3, T1G1-2 plurifocal or unifocal tumours and ≥ 2 occurrences within 24 months and was conducted from June 2004 to March 2007. Median follow-up for patients without recurrence was 12 months. Patients were randomized to BCG or mononuclear cells collected by apheresis after ex vivo cell processing and activation (BEXIDEM). Either arm treatment consisted of 6 weekly instillations and 2 cycles of 3 weekly instillations at months 3 and 6. Toxicity profile (primary endpoint) and prophylactic effects (secondary endpoint) were assessed.Results: Patient characteristics were evenly distributed. Of 73 treated with BCG and 64 with BEXIDEM, 85% vs. 45% experienced AEs and 26% vs. 14% serious AEs (SAE), respectively (p < 0.001). Recurrence occurred significantly less frequent with BCG than with BEXIDEM (12% vs. 38%; p < 0.001).Discussion: This initial report of autologous intravesical macrophage cell therapy in BC demonstrates BEXIDEM treatment to be safe. Recurrence rates were significantly lower with BCG however. As the efficacy of BEXIDEM remains uncertain, further data, e.g. marker lesions studies, are warranted. © 2010 Burger et al; licensee BioMed Central Ltd.

Mongiat-Artus P.,Paris West University Nanterre La Defense | Pfister C.,Service urologie | Theodore C.,Service Oncologie | de Crevoisier R.,Institute Gustave Roussy | Guillotreau J.,Toulouse University Hospital Center
Progres en Urologie | Year: 2010

Adjuvant therapies in bladder cancer are based on risk of recurrence and associated comorbidities (renal failure). Lymph node involvement is the most important prognostic factor for decision. Two adjuvant chemotherapies exist: MVAC or GC. In unfit patients, association (Gemcitabine and Taxanes) could be proposed. Indication of adjuvant radiotherapy depends on metastatic risk and resection margins. Concomitant chemotherapy and radiotherapy should be proposed to selected patients who refuse or are not candidate for radical cystectomy. © 2010 Published by Elsevier Masson SAS.

The diagnostic for prostate cancer is changing. To improve the detection of this cancer, urologists expect a lot from the contribution of magnetic resonance imaging (MRI). What is the role of this imaging in prostate cancer detection? This is a retrospective study, from 2011 to 2013, mono-centric and single-operator. Of the 464 needle biopsy of the prostate (BP), we excluded those with PSA > 20 ng/mL or digital rectal examination (DRE) > T3. The remaining 430 BP were submitted or not to a 1.5 tesla MRI with pelvic antenna. The primary aim is the overall detection of prostate cancer. Secondary aim was the detection rate during the first series of BP and repeat BP, between the two groups in the MRI group. MRI and MRI without populations are comparable for age (63.3 vs 64.6), PSA (6.10 vs 6.13), DRE > T1c, prostate volume (55.4 cm3 vs 51.7 cm3). There is no significant difference in overall detection between the two groups (P = 0.12). There is no significant difference in cancer detection between the first BP (P = 0.13) and the repeat BP (P = 0.07). There is a significant difference in the early detection of BP MRI group (P = 0.03) but not for the BP repeat MRI group (P = 0.07). For 108 BP iterative MRI group, there were 67 BP targeted "mentally" with MRI: 18 cancers were detected, making a 25% detection rate. This study helps to highlight the value of MRI in the early rounds of BP but we can ask the value of this imaging during repeat biopsies. Targeted biopsies "mentally" do not have the expected detection sensitivity and seems to require a three-dimensional reconstruction to be more effective. © 2015 Elsevier Masson SAS.

Faure J.P.,University of Poitiers | Breque C.,University of Poitiers | Danion J.,University of Poitiers | Delpech P.O.,Service urologie | And 2 more authors.
Surgical and Radiologic Anatomy | Year: 2016

Purpose: In primary and continuing medical education, simulation is becoming a mandatory technique. In surgery, simulation spreading is slowed down by the distance which exists between the devices currently available on the market and the reality, in particular anatomical, of an operating room. We propose a new model for surgical simulation with the use of cadavers in a circulation model mimicking pulse and artificial respiration available for both open and laparoscopic surgery. Methods: The model was a task trainer designed by four experts in our simulation laboratory combining plastic, electronic, and biologic material. The cost of supplies needed for the construction was evaluated. The model was used and tested over 24 months on 35 participants, of whom 20 were surveyed regarding the realism of the model. Results: The model involved a cadaver, connected to a specific device that permits beating circulation and artificial respiration. The demonstration contributed to teaching small groups of up to four participants and was reproducible over 24 months of courses. Anatomic correlation, realism, and learning experience were highly rated by users Conclusion: This model for surgical simulation in both open and laparoscopic surgery was found to be realistic, available to assessed objectively performance in a pedagogic program. © 2016 Springer-Verlag France

Bastide C.,Service urologie | Droupy S.,Nimes University Hospital Center | Ravaud A.,Service Oncologie | Depuydt-Baillon M.-G.,Service Geriatrie | Guillotreaue J.,Toulouse University Hospital Center
Progres en Urologie | Year: 2010

Elderly are often the population affected by bladder cancer. Physician must consider not only a patient's chronologic age but also physiologic age and associated medical conditions. Although radical cystectomy remains the treatment of choice for muscle invasive bladder cancer, it has a well-recognized risk of perioperative complications and mortality. Multidisciplinary oncogeriatric evaluation is necessary to detect associated comorbidities, and to improve oncologic decision and surgical outcomes. Radical cystectomy with ileal conduit is recommanded in elderly. Indications of conservative treatments depend on local extension, haematuria, and metastasis. © 2010 Published par Elsevier Masson SAS.

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