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de la Fouchardière C, Haissaguerre M, Decaussin-Petrucci M, Renaudin K, Deschamps F, Mirallié E, Murez T, Pattou F, Rocher L, Savoie PH, Faron M, Taieb D, Tabarin A, Bertherat J, Gimenez-Roqueplo AP, Amar L, Baudin E, Libé R. [French recommendations for malignant pheochromocytomas and paragangliomas by the national ENDOCAN-COMETE network]. Bull Cancer 2023; 110:1063-1083. [PMID: 37573200 DOI: 10.1016/j.bulcan.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, developed respectively in the adrenal medulla and in extra-adrenal locations. Their malignancy is defined by the presence of distant metastases. Forty percent of them are inherited and can be part of different hereditary syndromes. Their management is ensured in France by the multidisciplinary expert centers of the ENDOCAN-COMETE national network "Cancers of the Adrenal gland", certified by the National Cancer Institute and discussed within multidisciplinary team meetings. The diagnostic and therapeutic work-up must be standardized, based on an expert analysis of clinical symptoms, hormonal biological secretions, genetics, morphological and specific metabolic imaging. In the context of a heterogeneous survival sometimes beyond seven to ten years, therapeutic intervention must be justified. This is multidisciplinary and relies on surgery, interventional radiology, external or internal radiotherapy and medical treatments such as sunitinib or dacarbazine and temodal chemotherapy. The personalized approach based on functional imaging fixation status and genetics is progressing despite the extreme rarity of this disease.
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Affiliation(s)
| | - Magalie Haissaguerre
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | | | - Karine Renaudin
- CHU de Nantes, hôpital Hôtel-Dieu, anatomo-pathologie, Nantes, France
| | - Fréderic Deschamps
- Gustave-Roussy Cancer Campus, département de radiologie interventionnelle, Villejuif, France
| | - Eric Mirallié
- CHU de Nantes, hôpital Hôtel-Dieu, chirurgie cancérologique, digestive et endocrinienne, Institut des maladies de l'appareil digestif, Nantes, France
| | - Thibaut Murez
- CHU de Montpellier, département d'urologie et transplantation rénale, Montpellier, France
| | - François Pattou
- CHRU de Lille, département de chirurgie endocrinienne et métabolique, Lille, France
| | - Laurence Rocher
- Université Paris-Saclay, BIOMAPS, hôpital Antoine-Béclère, service de radiologie, Clamart, France
| | - Pierre-Henri Savoie
- Hôpital d'instruction des Armées Sainte-Anne, service d'urologie, Toulon, France
| | - Matthieu Faron
- Gustave-Roussy Cancer Campus, service de chirurgie viscérale oncologique, Villejuif, France
| | - David Taieb
- La Timone University Hospital, CERIMED, Aix-Marseille University, département de médecine nucléaire, Marseille, France
| | - Antoine Tabarin
- CHU de Bordeaux, hôpital Haut Lévêque, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Pessac, France
| | - Jérôme Bertherat
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France
| | | | - Laurence Amar
- Hôpital européen Georges-Pompidou, service d'hypertension artérielle, Paris, France
| | - Eric Baudin
- Gustave-Roussy Cancer Campus, service de cancérologie endocrine, centre coordonnateur ENDOCAN-COMETE, Villejuif, France
| | - Rossella Libé
- Hôpital Cochin, CHU de Paris-Centre, service d'endocrinologie, centre coordonnateur ENDOCAN-COMETE, Paris, France.
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Lasocki S, Delahaye D, Fuks D, Savoie PH, Dussart C, Hofmann A, Paubel P. Management of perioperative iron deficiency anemia as part of patient blood management in France: A budget impact model-based analysis based on real world data. Transfusion 2023; 63:1692-1700. [PMID: 37610057 DOI: 10.1111/trf.17495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Patient Blood Management (PBM) is defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood, while promoting patient safety and empowerment. As a corollary, it also reduces the utilization of allogeneic blood components. However, demonstrating cost-effectiveness depends on the health insurance system considered. This analysis aims to estimate the one-year budget impact of PBM in four elective surgical areas, from French National Health Insurance and hospital perspectives. METHODS A budget impact model was developed to estimate the difference in the cost of care between scenarios with and without PBM. The impact of hematopoiesis optimization (first pillar of PBM) was studied throughout the management of preoperative anemia and iron deficiency in four types of surgeries: orthopedic, cardiac & cardiovascular, vascular & thoracic, and urologic & visceral surgery. Estimation of model's parameters was based on data collected in 10 French hospitals, literature, and on data from the French national medico-administrative database. RESULTS A total of 980,125 patients were modeled for all four therapeutic areas. Results shows that implementation of a PBM program could generate annual savings up to €1079 M from the French National Health Insurance perspective (€1018 M from the hospital perspective), and the sparing of 181,451 red blood cells units per year. The deterministic sensitivity analysis showed that PBM generates savings for both perspectives in most parameters tested. CONCLUSION Implementing PBM programs could result in important savings for the health care system in France.
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Affiliation(s)
- Sigismond Lasocki
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - D Delahaye
- Département Anesthésie Réanimation, Assistance Publique - Hôpitaux de Marseille, hôpital Sainte-Marguerite, Marseille, France
| | - D Fuks
- Département de chirurgie digestive hépato-billiaire endocrinienne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - P H Savoie
- Service d'Urologie, Hôpital d'Instruction des armées Sainte Anne, Toulon, France
| | - C Dussart
- Hospices Civils de Lyon, Lyon, France
| | - A Hofmann
- University of Western Australia, Perth, Australia, University Hospital Zurich, Zurich, Switzerland
| | - P Paubel
- Inserm UMR S 1145, Université Paris Cité, Paris, France
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Holay Q, Baboudjian M, Lechevallier E, André M, Savoie PH. Percutaneous embolization by direct puncture for the treatment of high-flow priapism. Asian J Urol 2023; 10:208-209. [PMID: 36942118 PMCID: PMC10023522 DOI: 10.1016/j.ajur.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Indexed: 10/15/2022] Open
Affiliation(s)
- Quentin Holay
- Department of Radiology, Conception Academic Hospital, Marseille, France
| | | | - Eric Lechevallier
- Department of Urology, Conception Academic Hospital, Marseille, France
| | - Marc André
- Department of Radiology, Conception Academic Hospital, Marseille, France
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Gravis G, Sfumato P, Ploussard G, Savoie PH, Durand M, Mathieu R, Rebillard X, Pignot G, Beauval JB, Ahallal Y, Vincendeau S, Guerin M, Boudin L, Crouzet S, Salem N, Vicier C, Boher JM, Marino P, Walz J. Safety and quality of life analyses of apalutamide plus active surveillance vs active surveillance alone for low, intermediate risk prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
352 Background: Active surveillance (AS) is a standard of care for low-risk prostate cancer (PC). However, 20 to 50% of patients (pts) will ultimately require a local treatment following AS. The aim of this study is to assess whether apalutamide could decrease the proportion of pts requiring local treatment within 3 years. We report the 1-year safety and quality of life analyses. Methods: multicentric phase II study conducted in patients with low to intermediate risk PC randomized between apalutamide 6 months (240 mg/d) with AS vs AS alone. Toxicity was evaluated each month during treatment and every 3 months thereafter for both arms. Quality of life (SF12) was assessed at baseline, 6 and 12 months post enrollment. Results: Patients were randomized: 51 in apalutamide and 40 in AS arm. Only 50 pts received apalutamide (one refusal). Median age was 64 yrs (47-76), median PSA 5.9 (1.5-21.5), only 2 pts had Gleason ISUP 2, 14% had >T2, the median cancer positive cores was 14.3%. The median testosterone level was 4.7 mg/l. Only 88 were available for safety analyses (48 in apalutamide arm). Maximal grades of reported adverse events during the first year were for the experimental arm: 25%, 56%, 19% and control arm: 20%, 15% 12.5% for G1, G2, G3 respectively. In the experimental arm, grade 1/2 related adverse events (AE) were cutaneous (25%) and HTA (15%), nausea 15%, diarrhea 10%, arthralgia or musculoskeletal event 17% and anemia 6%. Attention disorders were observed in 6% and hypothyroidism in 8%. The most frequent sexual dysfunctions were erectile dysfunction observed in 29% (7.5% in AS arm), gynecomastia in 60%, loss of libido in 21%, and nipple pain in 33%. One-year post enrollment, the testosterone level was 4.86 mg/l (1.5-9.8) vs 4.6 (2-7.7) in apalutamide and AS arm, respectively. Digestive symptoms were Grade 3. Related AEs were an HTA for 2 pts, rash for 1 pt, asthenia for 1 pt, erectile dysfunction for 1 pt, and decreased libido for 1 pt. One serious related AE was reported: grade 2 cerebral ischemic attack. A reduced dose was required for 16.67% of pts and 33.3% had transient discontinuation. The treatment was stopped for toxicity in 3 pts; 94% completed the 6 months of treatment. No differences were observed in physical component summary (PCS) and mental component summary (MCS) of SF12 for treatment vs AS at 6 mo (PCS: 55.1 vs 56.4; MCS 43.4 vs 41.4) and 12 mo (PCS: 53.6 vs 54.1; MCS 44.1 vs 42.9). Conclusions: This is a large randomized study evaluating apalutamide with active surveillance vs active surveillance. No new safety issues were observed and the safety profile was consistent relative to those previously described with apalutamide and castration, no falls or fracture were observed. No detrimental effect of apalutamide on QOL was observed during and after treatment. AEs are important for pts candidates for active surveillance. Clinical trial information: NCT03088124 .
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Affiliation(s)
- Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Universite, CRCM, Marseille, France
| | - Patrick Sfumato
- Paoli Calmettes Institute, Department of Clinical Research and Innovation, Statistics and Methodology Unit, Marseille, France
| | | | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Matthieu Durand
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | | | | | - Jean-Baptiste Beauval
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, Quint Fonsegrives, France
| | - Youness Ahallal
- Department of Urology, Pasteur University Hospital, Nice, France
| | | | - Mathilde Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Université, CRCM, Marseille, France
| | - Laurys Boudin
- Department of Oncology, Sainte Anne Military Teaching Hospital, Toulon, France
| | - Sebastien Crouzet
- Urology Department, Edouard Herriot Hospital, University of Lyon, Lyon, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | | | - Jean-Marie Boher
- Department of Clinical Research and Innovation, Statistics and Methodology Unit, Paoli-Calmettes Institute, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, SESSTIM, INSERM, IRD, Aix Marseille University, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
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Savoie PH, Murez T, Neuville P, Van Hove A, Rocher L, Fléchon A, Camparo P, Ferretti L, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines Update 2022-2024: Adrenal tumor - Assessment of an adrenal incidetaloma and oncological management. Prog Urol 2022; 32:1040-1065. [PMID: 36400477 DOI: 10.1016/j.purol.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The objective of this publication is to recall the initial work-up when faced with an adrenal incidentaloma and, if necessary, to establish the oncological management of an adrenal malignant tumor. MATERIAL AND METHODS The multidisciplinary working group updated French urological guidelines about oncological assessment of the adrenal incidentaloma, established by the CCAFU in 2020, based on an exhaustive literature review carried out on PubMed. RESULTS Although the majority of the adrenal masses are benign and non-functional, it is important to investigate them, as a percentage of these can cause serious endocrine diseases or be cancers. Malignant adrenal tumors are mainly represented by adrenocortical carcinomas (ACC), malignant pheochromocytomas (MPC) and adrenal metastases (AM). The malignancy assessment of an adrenal incident includes a complete history, a physical examination, a biochemical/hormonal assessment to look for subclinical hormonal secretion. Diagnostic hypotheses are sometimes available at this stage, but it is the morphological and functional imaging and the histological analysis, which will make it possible to close the malignancy assessment and make the oncological diagnosis. CONCLUSIONS ACC and MPC are mainly sporadic but a hereditary origin is always possible. ACC is suspected preoperatively but the diagnosis of certainty is histological. The diagnosis of MPC is more delicate and is based on clinic, biology and imagery. The diagnosis of certainty of AM requires a percutaneous biopsy. At the end, the files must be discussed within the COMETE - adrenal cancer network (Appendix 1).
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, Camparo P, Fléchon A, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer. Prog Urol 2022; 32:1010-1039. [PMID: 36400476 DOI: 10.1016/j.purol.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update French oncology guidelines concerning penile cancer. METHODS Comprehensive Medline search between 2020 and 2022 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organsparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital Européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, Boulevard Sainte Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Abstract
INTRODUCTION To report the epidemiology and the care pathway for urological emergencies in France for the official report of the 115th Congres Francais d'Urologie. METHODS We made a request to the Institut de Veille Sanitaire and its network Surveillance Sanitaire des Urgences et des Décès (SurSaUD®). Within this system, the OSCOUR® network (Organisation de la surveillance coordonnée des urgences) centralizes in real time the data of emergency visits from more than 720 emergency departments throughout the national territory (>93% of the national territory covered by the OSCOUR® network). For each emergency defined by its CIM-10 code, the following data were collected from 2014 to 2019: age, gender, length of stay and post-emergency status (hospitalization vs. return home). RESULTS From 2014 to 2019, urological emergencies represented on average 4.2% of all emergencies, with an average 591,080±66,782 passages/year including 25% that resulted in hospitalization. Infectious disease represented 35% of all urological emergencies. The 3 most common urologic emergencies were: renal colic, acute urine retention and hematuria for men; acute cystitis, pyelonephritis and renal colic for women. CONCLUSION In an analysis of the OSCOUR® (Organisation de la surveillance coordonnée des urgences) registry, we determined the epidemiological profiles of the main urological emergencies with contemporary data.
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Affiliation(s)
- R Boissier
- Université Aix-Marseille, Service d'Urologie et de transplantation Rénale, CHU La Conception, AP-HM, Marseille, France.
| | - P H Savoie
- Service d'urologie, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France
| | - J-A Long
- Service d'urologie et de la transplantation rénale, CHU Grenoble, France; TIMC-IMAG CNRS 5525, France
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Seizilles de Mazancourt E, Vallée M, Sotto A, Le Goux C, Dihn A, Therby A, Boissier R, Savoie PH, Long JA, Bruyere F. [Infectious emergencies in urology]. Prog Urol 2021; 31:978-986. [PMID: 34420878 DOI: 10.1016/j.purol.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology. MATERIAL AND METHODS Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies. RESULTS Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection. CONCLUSION Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.
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Affiliation(s)
- E Seizilles de Mazancourt
- Service d'urologie et de la transplantation, Hôpital Édouard-Herriot, hospices civils de Lyon, 69008 Lyon, France
| | - M Vallée
- Service d'urologie, CHRU Poitiers, 86000 Poitiers, France
| | - A Sotto
- Service de maladies infectieuses, CHU Nîmes, 30000 Nîmes, France
| | - C Le Goux
- Centre Alfred-Kastler, Hôpital privé Nord parisien, 95200 Sarcelles, France
| | - A Dihn
- Service de maladies infectieuses, CHU Garches, 92380 France
| | - A Therby
- Service de maladies infectieuses, CH Versailles, 78150 France
| | - R Boissier
- Hopital de la conception, Assistance publique Hôpitaux de Marseille, 13005, France
| | - P H Savoie
- Hôpital d'Instruction des Armées Saint-Anne, BP 600, 83190 Toulon cedex 09
| | - J A Long
- Service d'urologie, Centre hospitalier universitaire de Grenoble, 38000 France; TIMC-IMAG, CNRS 5525, France
| | - F Bruyere
- Service d'urologie, CHRU Tours, 2, boulevard Tonnellé, 37044 Tours cedex, France.
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9
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Deledalle FX, Ambrosetti D, Durand M, Michel F, Baboudjian M, Gondran-Tellier B, Lannes F, Daniel L, André M, Fais PO, Savoie PH, Durand X, Rossi D, Karsenty G, Bastide C, Lechevallier E, Boissier R. Active Surveillance for Biopsy Proven Renal Oncocytomas: Outcomes and Feasibility. Urology 2021; 156:185-190. [PMID: 34087310 DOI: 10.1016/j.urology.2021.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To report the outcomes and feasibility of active surveillance (AS) of biopsy-proven renal oncocytomas. METHODS Multicentric retrospective study (2010-2016) in 6 academic centers that included patients with biopsy-proven renal oncocytomas who were allocated to AS (imperative or elective indication) with a follow-up ≥1 year. Imaging was performed at least once a year, by CT-scan or ultrasound or MRI. Conversion to active treatment (surgical excision or ablative treatment) was at the discretion of the urologist. The primary endpoint was renal tumor growth (cm/year). Secondary outcomes included accuracy of biopsy, incidence, and reason to change AS to active treatment. RESULTS Eighty-nine patients were included: Median age 67 years (26-89) and median tumor size 26 mm [15-90] on diagnosis. During a mean follow-up of 43 months'' (median 36 [12-180]), mean tumor growth was 0.24 cm/year. No predictive factors (demographical, radiological or histologic) of tumor growth could be identified. Conversion from AS to active treatment occurred in 24 patients (27%) (13 surgical excisions, 11 ablative procedures), in a median time of 45 (12-76) months'' after diagnosis. Tumor growth was the main indication to convert AS to active treatment (58%) with 8% of the patients opting to discontinue AS. No patient had metastatic progression nor disease-specific death. The correlation between biopsy and surgical specimen was 92%. CONCLUSION Active surveillance for biopsy-proven renal oncocytomas was oncologically safe and patient adherence was high. No predictive factor for tumor growth could be identified but the tumor growth rate was low, and biopsy efficacy was high.
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Affiliation(s)
| | - Damien Ambrosetti
- Department of Pathology, Nice University, Pasteur University Hospital, Nice, France
| | - Mathieu Durand
- Department of Urology, Nice University, Pasteur University Hospital, Nice, France
| | - Floriane Michel
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France
| | - Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France
| | - François Lannes
- Department of Urology, Aix-Marseille University, APHM, Nord University Hospital, Marseille, France
| | - Laurent Daniel
- Department of Pathology, Aix-Marseille University, APHM, La Timone University Hospital, Marseille, France
| | - Marc André
- Department of Radiology, Aix-Marseille University, APHM, La Conception University Hospital, Marseille, France
| | | | | | - Xavier Durand
- Department of Urology, Military Hospital Bégin, Saint Mandé, France
| | - Dominique Rossi
- Department of Urology, Aix-Marseille University, APHM, Nord University Hospital, Marseille, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France
| | - Cyrille Bastide
- Department of Urology, Aix-Marseille University, APHM, Nord University Hospital, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception University Hospital, Marseille, France.
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10
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Boudin L, de Lesquen H, Patient M, Romeo E, Rivière D, Cungi PJ, Savoie PH, Avaro JP, Dagain A, Bladé JS, Balandraud P, Bourgouin S. Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study. Mil Med 2021; 186:e469-e473. [PMID: 33135732 DOI: 10.1093/milmed/usaa327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/29/2020] [Accepted: 08/20/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The maintenance of military surgeons' operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons' activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons' operative skills. METHODS Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). RESULTS Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85-3.14). CONCLUSION This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.
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Affiliation(s)
- Laurys Boudin
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Henri de Lesquen
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Matthieu Patient
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Emilie Romeo
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Damien Rivière
- Head and Neck Surgery Department, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Julien Cungi
- Department of Anaesthesia and Critical Care, Sainte Anne Military Hospital, Toulon 83000, France
| | - Pierre-Henri Savoie
- Department of Urology, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Jean-Philippe Avaro
- Department of Thoracic and Vascular Surgery, Sainte Anne Military Hospital, Toulon 83000, France.,French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France
| | - Arnaud Dagain
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Neurosurgery, Sainte Anne Military Hospital, Toulon 83000, France
| | - Jean-Sébastien Bladé
- Department of Oncology and Haematology, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Paul Balandraud
- French Military Health Service Academy, Val-de-Grâce Academy, Paris 75005, France.,Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
| | - Stéphane Bourgouin
- Department of Digestive Surgery, Sainte Anne Military Hospital, Toulon 83000, Var, France
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11
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Rocher L, Feretti L, Camparo P, Savoie PH, Morel-Journel N, Murez T, Sebe P, Flechon A, Méjean A, Durand X. [Non-palpable testicular tumors in adults: A management based on imaging? Issue from the French Urologic Association Genital Cancer committee's edit]. Prog Urol 2018; 28:407-415. [PMID: 29650457 DOI: 10.1016/j.purol.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 03/14/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Help in management of non-palpable testicular tumors. French Urologic Association Genital cancer committee's Edit. OBJECTIVES To review their characterization at imaging findings of non-palpable testicular tumors. DOCUMENTARY SOURCES Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: non-palpable/incidental testicular tumors; color Doppler ultrasound; US elastography; magnetic resonance imaging; contrast enhanced sonography; partial surgery. RESULTS Color Doppler is the basic exam. The size, the presence of microlithts/microlithiasis/macrocalcifications, the vascular architecture are major semiological findings to suggest the benign or the malignant nature of the lesion. Other techniques like multiparametric MRI, contrast-enhanced sonography, sonographic elastography are still in evaluation. The frequency of benign tumors such as Leydig cell tumors lead to preservation management, through improved characterization, monitoring or tumorectomy. LIMITS Non-randomized study - a very few prospective studies. CONCLUSION The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on the suspected nature of the tumors.
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Affiliation(s)
- L Rocher
- Service de radiologie diagnostique et interventionnelle, hôpitaux Paris-Sud, site Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Faculté Paris-Sud, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; IR4M, imagerie par résonance magnétique médicale et multi-modalités, CNRS, université Paris-Sud, 91405 Orsay cedex, France.
| | - L Feretti
- Service de chirurgie viscérale et cœlioscopique, hôpital d'Instruction des Armées, 351, route de Toulouse, 33140 Villenave-d'Ornon, France
| | - P Camparo
- Centre de pathologie Amiens-Picardie, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - P H Savoie
- Service d'urologie, hôpital d'Instruction des Armées Sainte-Anne, BP 600, 83800 Toulon cedex 09, France
| | - N Morel-Journel
- Urologie, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Service d'urologie et de transplantation rénale, CHRU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - P Sebe
- Groupe hospitalier Diaconesses-Croix-Saint-Simon, 75012 Paris, France
| | - A Flechon
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - A Méjean
- Service d'urologie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - X Durand
- Hôpital IA Begin/Val-de-Grâce, 74, boulevard de Port-Royal, 75230 Paris, France
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12
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Bonnet S, Bertani A, Savoie PH, Mathieu L, Boddaert G, Gonzalez F, Poichotte A, Durand X, Rongiéras F, Balandraud P, Pons F, Rigal S. Humanitarian Surgical Care Provided by a French Forward Surgical Team: Ten Years of Providing Medical Support to the Population of the Ivory Coast. Mil Med 2015; 180:1075-82. [DOI: 10.7205/milmed-d-14-00688] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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13
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van Hove A, Savoie PH, Maurin C, Brunelle S, Gravis G, Salem N, Walz J. Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World J Urol 2014; 32:847-58. [PMID: 24919965 DOI: 10.1007/s00345-014-1332-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/21/2014] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The clinical utility of image-targeted biopsies can only be judged by a comparison of the current standard of systematic 10-12 core biopsy schemes. The aim of this review was to gather the current evidence in favor of or against targeted biopsies in the detection of prostate cancer based on well-designed, controlled studies, in order to draw clinical relevant conclusions. SUBJECTS/PATIENTS AND METHODS A systematic literature review was performed addressing studies that compared the prostate cancer detection rates of targeted and systematic biopsy schemes using the imaging techniques of elastography, contrast-enhanced ultrasound, histoscanning and multiparametric MRI. Only well-designed, controlled studies were included and the results summarized. RESULTS All imaging techniques are associated with varying results regarding better or poorer detection rates relative to systematic biopsies. No technique provides a clear trend in favor of or against image-targeted biopsies. In almost all studies, the combination of targeted and systematic biopsies provided sometimes a substantial, increase in the detection rate relative to systematic biopsies alone. MRI-targeted biopsies show no advantage in the initial biopsy setting, whereas in the repeat biopsy setting improvements in the detection rates are often observed relative to systemic biopsies. CONCLUSION Based on well-designed, controlled studies no clear advantage of targeted biopsies over the current standard of systematic biopsies can be observed. Therefore, targeted biopsies cannot replace systematic biopsies in the diagnosis of prostate cancer. In all indications, the combination of systematic and targeted biopsy schemes provides the highest detection rate.
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Affiliation(s)
- Antoine van Hove
- Department of Urology, Institut Paoli-Calmettes Cancer Centre, 232, Boulevard Ste. Marguerite, BP 156, 13273, Marseille, France
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14
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Pasquier P, Malgras B, Savoie PH, Chrisment A, Dubost C, Mérat S. Application of negative-pressure wound therapy for the management of battlefield scrotum trauma. Injury 2013; 44:1250-1. [PMID: 23726143 DOI: 10.1016/j.injury.2013.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 05/11/2013] [Indexed: 02/02/2023]
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15
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Coquet B, Sandoz B, Savoie PH, Thollon L, Serre T, Brunet C. Anthropometric characterization of spleen in children. Surg Radiol Anat 2009; 32:25-30. [PMID: 19669612 DOI: 10.1007/s00276-009-0535-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 07/25/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE This paper aims to characterize the 3D geometry of the child spleen which is still unknown. METHODS An anthropological measurement protocol, based upon 3D modeling using spleen-computed tomography data, was set up. Characteristic measurements were defined to allow dimensions and spatial localization description from classical anatomical landmarks (11th dorsal vertebra and 10th left rib). RESULTS Growth patterns showed a global enlargement without significant changes in distance to anatomical bone points. CONCLUSIONS This preliminary study describes a validated measurement protocol based on 3D reconstructions and gives description of the child spleen during growth.
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Affiliation(s)
- Benjamin Coquet
- Department of Digestive Surgery, Hôpital Nord, Chemin Bourrely, Marseille Cedex, France
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16
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Peycru T, Guiramand J, Tardat E, Savoie PH, Avaro JP, Balandraud P. Nodular ganglioneuroblastoma in adults. Can J Surg 2009; 52:E111-E113. [PMID: 19680497 PMCID: PMC2724818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Thierry Peycru
- Service de chirurgie viscérale, Hôpital d’instruction des armées (HIA) Robert Picqué, Bordeaux, the
| | - Jérôme Guiramand
- Service de chirurgie oncologique 1, l’Institut Paoli Calmette, and the
| | - Eric Tardat
- Service de chirurgie viscérale, Hôpital d’instruction des armées (HIA) Robert Picqué, Bordeaux, the
| | - Pierre-Henri Savoie
- Service de chirurgie viscérale, Hôpital d’instruction des armées (HIA) Robert Picqué, Bordeaux, the
| | | | - Paul Balandraud
- Service de chirurgie viscérale, HIA Laveran, Marseille, France
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17
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Savoie PH, Bonnet PM, Avaro JP, Peycru T, Bertani A, Farthouat P. [Recent injuries to the left diaphragm: value of laparoscopy in Africa and Europe]. Med Trop (Mars) 2008; 68:529-532. [PMID: 19068989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Management of recent diaphragm injury is challenging. The purpose of this report is to describe two patients who presented injuries to the left diaphrgmatic cupola, i.e., rupture due to blunt trauma in Europe and a stab wound in Africa. The value of laparoscopy for diagnosis and treatment are discussed in these contrasting settings.
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Affiliation(s)
- P H Savoie
- Service de chirurgie viscéale et urologique, Hôpital d'Instruction des Armées Laveran, Marseille.
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18
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Crochet P, Savoie PH, Agostini A, Zaritsky E, Lechevallier E, Coulange C. Uretero-Fallopian Fistula After Gynecological Surgery for Endometriosis: A Case Report. J Minim Invasive Gynecol 2008; 15:108-9. [DOI: 10.1016/j.jmig.2007.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 07/24/2007] [Accepted: 07/28/2007] [Indexed: 10/22/2022]
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19
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Balandraud P, Biance N, Peycru T, Savoie PH, Avaro JP, Tardat E, Pourrière M, Cador L. [Abbreviated laparotomy for treatment of severe abdominal trauma: use in austere settings]. Med Trop (Mars) 2007; 67:529-535. [PMID: 18225739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Abbreviated laparotomy is a recent technique for management of patients with severe abdominal trauma. It is based on a unified approach taking into account the overall extent of injury and the victim's physiologic potential to respond to hemorrhage. It is the first step in a multi-modal strategy. The second step is the critical care phase. The third step consists of "second-look" laparotomy that should ideally be performed on an elective basis within 48 hours and is aimed at definitive treatment of lesions. The goal of abbreviated laparotomy is damage control using temporary quick-fix procedures limited to conspicuous lesions and rapid hemostasis and/or viscerostasis procedures so that the patient can survive the acute critical period. Tension-free closure of the abdominal wall, if necessary using laparostomy, is essential to avoid abdominal compartment syndrome. With reported survival rates of about 50% in Europe and the United States, this simple life-saving technique that requires limited resources should be introduced in Africa where severe abdominal trauma often involves young patients.
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Affiliation(s)
- P Balandraud
- Service de chirurgie viscérale, Hôpital d'instruction des armées Laveran, Marseille.
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20
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Savoie PH, Lafolie T, Gabaudan C, Biance N, Avaro JP, André M, Bertrand S, Balandraud P. [Late complication of selective renal arterial embolization after percutaneous surgery: renal "colic"]. Prog Urol 2007; 17:869-71. [PMID: 17634005 DOI: 10.1016/s1166-7087(07)92311-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion.
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Affiliation(s)
- Pierre-Henri Savoie
- Service de chirurgie urologique, Hôpital d'Instruction des Armées Laveran, Marseille.
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21
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Savoie PH, Peycru T, Mingoutaud L, Sow A, Biance N, Pauleau G, Garcia L, Farthouat P. [Primary peritonitis in Sub-Saharian Africa: a 15 case series]. Med Trop (Mars) 2007; 67:154-8. [PMID: 17691434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Primary peritonitis (PP) is an infection of the peritoneal cavity occurring in the absence of a documented intraabdominal source of contamination. It is one of the main infectious complications of cirrhosis but is rare in healthy subjects. The purpose of this retrospective study is to describe a series of 15 cases of PP treated over a 3-year period at the Principal Hospital in Dakar, Senegal. The patient population was young (all but 2 under age of 13 years) and predominantly female (87%) with no predisposing factors. Clinical presentation always involved typical peritonitis. Surgical exploration was performed in all cases by laparotomy (n=13) or laparoscopy (n=2). Intra-operative bacteriologic sampling was performed systematically. Probabilistic antimicrobial therapy was administered in all cases using a triple-drug combination including a cephalosporin or betalactamine, an aminoside and metronidazole. This unconventional combination was designed to allow low-cost wide-spectrum coverage. As in patients with cirrhosis, the most common microbial agents were gram-negative bacteria (47%). Streptococcus pneumoniae was identified in 40% of cases. Infectious ORL and pulmonary sites were suspected in some cases. Although no supporting bacteriologic evidence was obtained, the high frequency of pneumococcal involvement as well as the age and female predominance of the patient population is consistent with contamination via the female genital tract. The cases in this series present unusual epidemiological, clinical and bacteriologic features. In Europe surgical treatment can be avoided thanks to the availability of modern facilities to support further laboratory examinations. In Africa antimicrobial therapy and peritoneal lavage are the mainstay treatments. Use of laparoscopy should be expanded.
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Affiliation(s)
- P H Savoie
- Service de chirurgie viscérale, urologique et thoracique, Hôpital d'Instruction des Armées Laveran de Marseille, France.
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22
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Biance N, Peycru T, Savoie PH, Avaro JP, Tardat E, Bertrand S, Balandraud P. [Small intestinal metastasis from non-intestinal tumors 1. Which primary tumors?]. ACTA ACUST UNITED AC 2006; 143:129-32. [PMID: 16788557 DOI: 10.1016/s0021-7697(06)73638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Peycru T, Biance N, Avaro JP, Savoie PH, Tardat E, Balandraud P. [Mesenteric trauma: management in austere environments]. Med Trop (Mars) 2006; 66:199-204. [PMID: 16775948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Mesenteric trauma, i.e., injuries located in the bowel or organs supplied by the superior mesenteric artery, can be life-threatening. The incidence of these lesions is low. Most occur as result of blunt and penetrating abdominal trauma due mainly to gunshot wounds or road accidents. Management of these serious injuries can be challenging in the military field hospitals. The major problem in austere environment is the unavailabiity of computerized axial and other tools gene rally used for diagnosis. As an alternative to tomography diagnostic peritoneal lavage can be used with a high sensitivity for the detection of mesenteric trauma. The second difficulty is technical. General surgeons without vasular training or supplies must prepared to suspect and reonstuct lesions of the superior mesenteric available resources.
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Affiliation(s)
- T Peycru
- Service de chirurgie viscérale, vasculaire et thoracique, Hôpital d'Instruction des Armées Laveran, Boulevard Alphonse Laveran, Marseille.
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