[Non-alcoholic steatohepatitis (NASH) : a model of metabolic inflammation («metaflammation¼)]. / Stéatohépatite non alcoolique (NASH) : un modèle d'inflammation métabolique («métaflammation¼).

Diseases related to fatty liver, independently of alcohol consumption («non-alcoholic fatty liver disease¼ or NAFLD), are increasing because of the epidemics of obesity and type 2 diabetes. These disorders reflect a continuum that comprises isolated steatosis, steatohepatitis (NASH) and fibrosis, with, at the end, an increased risk of cirrhosis and hepatocarcinoma. It has been recently proposed to replace the term NAFLD by MAFLD, i.e. «Metabolic (dysfunction) Associated Fatty Liver Disease¼, which better reflects the pathogenesis of the disease. Inflammation plays a crucial role in the aggravation of the disorder and profoundly influences the prognostic evolution. This article illustrates the natural history of this underestimated metabolic disorder, recall the diagnostic criteria used in clinical practice, emphasizes the deleterious role of inflammation and discusses some therapeutic perspectives.

: Les maladies liées à un «foie gras¼, indépendamment de la consommation d'alcool («non-alcoholic fatty liver disease¼ ou NAFLD), sont en augmentation en raison de l'«épidémie¼ d'obésité et de diabète de type 2. Il s'agit d'un continuum comprenant la stéatose isolée, la stéatohépatite (NASH) et la fibrose avec, in fine, un risque accru de cirrhose et d'hépatocarcinome. Il a été proposé récemment de remplacer le terme NAFLD par MAFLD pour «Metabolic (dysfunction) Associated Fatty Liver Disease¼, ce qui reflète mieux la pathogénie de la maladie. L'inflammation joue un rôle clé dans l'aggravation du trouble et conditionne l'évolution pronostique. Cet article retrace l'histoire naturelle de cette pathologie métabolique sous-estimée, rappelle les critères diagnostiques utilisés en clinique, précise le rôle délétère de l'inflammation et conclut par quelques perspectives thérapeutiques.

[Technique and management of urinary catheterization in men]. / Technique et gestion du sondage vésical chez l'homme.

INTRODUCTION: In France, the urinary catheterization especially in men, is governed by Article R. 4311-10 of Decree No. 2004-802 of 29 July 2004 of the Public Health Code. Although this gesture is framed by law, there is currently no French guidelines formalized on a single and easily accessible support for the technique and management of the urinary catheterization. The aim of this study was to provide a simple reference about technical aspects and management of urinary catheterization in men. MATERIALS AND METHODS: The European recommendations on urinary catheterization were updated and adapted with additional arguments in certain situations to cover all aspects of urinary catheterization. This work was conducted to improve the nurses knowledge about this topic. RESULTS: We give here a reproducible technique in order to limit complications related to the most frequent invasive gesture in urology. We also propose a scheme to harmonize the management of indwelling urinary catheterization. CONCLUSION: This work gives to nurses a practical document in order to standardize and to secure a gesture governed by dogmas since too long. The drafting of guidelines and the creation of educational tools for medical and para-medical personnel would probably improve practices in this topic. LEVEL OF EVIDENCE: 4.

[Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]. / Résultats oncologiques à long terme des patients ayant un cancer de la prostate traité par prostatectomie totale et curage ganglionnaire avec atteinte métastatique ganglionnaire infraclinique.

INTRODUCTION: The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. PATIENTS AND METHODS: This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. RESULTS: Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. CONCLUSION: Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. LEVEL OF EVIDENCE: 4.

[Pediatric reference intervals : retrospective study on thyroid hormone levels]. / Etude rétrospective du bilan thyroïdien : définition de valeurs de référence pédiatriques.

Defining reference range is an essential tool for diagnostic. Age and sexe influences on thyroid hormone levels have been already discussed. In this study, we are defining a new pediatric reference range for TSH, FT3 and FT4 for Cobas C6000 analyzer. To do so, we have taken in account 0 to 18 year old outclinic patients. During the first year of life, thyroid hormone levels change dramatically before getting stabilized around 3 years old. We also compared our results to those obtained in a Canadian large-scale prospective study (the CALIPER initiative).

L'établissement de valeurs de référence thyroïdiennes pédiatriques est un élément essentiel dans l'aide au diagnostic des dysfonctionnements thyroïdiens chez l'enfant et l'adolescent. L'influence de l'âge et du sexe sur les concentrations des hormones thyroïdiennes a de nombreuses fois été évoquée. Dans cette étude, nous définissons un nouvel intervalle de référence pédiatrique pour la TSH, la FT3 et la FT4 sur l'analyseur Cobas C6000 (Roche). Pour ce faire, nous avons collecté les données des patients ambulants de 0 à 18 ans de notre institution. Au cours de la première année, les valeurs d'hormones thyroïdiennes fluctuent fortement avant de se stabiliser vers l'âge de 3 ans. Nous comparons également nos résultats à ceux d'une étude prospective de grande ampleur menée au Canada (étude CALIPER). e.

[Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review]. / Analyse des taux de succès des urétroplasties pour sténoses de l'urètre bulbaire chez l'homme adulte : revue systématique de la littérature.

Male urethral stricture disease is prevalent and has an important impact on quality of life. Direct visual urethrotomy and dilatations have high rates of recurrence. OBJECTIVES: The aim of this review of literature was to evaluate the success rates of different techniques of urethroplasty for strictures of the bulbar urethra. METHODS: We performed a systematic review of the MEDLINE literature from 2004 to 2015 following the PRISMA's statement recommendations. Key words were: urethroplasty, urethral reconstruction, onlay, graft, urethral stricture. Inclusion criteria were original articles describing the results of urethroplasty for bulbar urethral stricture in an adult male population. A minimum follow-up of 24 months was required. RESULTS: From 891 articles of the literature, 20 are studied in this review. Only 3 studies were prospective. The success rate of anastomotic urethroplasty varied from 68.7 to 98.8% for strictures from 1 to 3.5cm, from 60 to 96.9% for augmented urethroplasty performed for strictures from 4.2 to 4.7cm. Substitution urethroplasty with grafts presented from 75 to 89.8% of success for strictures from 2.6 and 4.36cm. Overall, 19/20 studies used buccal mucosal graft. CONCLUSION: The success rate of urethroplasty for bulbar urethral stricture is high; the surgical technique should be adapted to the length of the stricture.

[Flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in neurologic patients with severe motor disability]. / L'urétérorénoscopie souple avec fragmentation laser dans le traitement des calculs du haut appareil urinaire chez les patients atteints d'une maladie du système nerveux avec un handicap moteur sévère.

OBJECTIVE: The study's objective was to evaluate the effectiveness and morbidity of flexible ureterorenoscopy and laser lithotripsy for upper urinary tract stones in patients with a nervous system pathology including severe motor disability. METHODS: Between 2006 and 2013, we retrospectively analyzed 83 flexible ureterorenoscopy to treat 63 kidneys in 42 patients. Stone free (SF) kidneys defined as an absence of stones on computerized tomography, renal ultrasound, X-ray or direct ureterorenoscopy, were considered a surgical success. Complications were classified according to the Clavien-Dindo system. RESULTS: Success rates were 49.2 %, 57.1 % and 58.7 %, respectively after first, second and third flexible ureterorenoscopy procedure. Clearance after one procedure was achieved in 64.3 % of cases involving less than 20mm stones. No major complication (Clavien-Dindo>2) was described (0 %). Complication rates were 44.7 %, with 31.6 % Clavien-Dindo 2. The main complication was urosepsis, which occurred in 27.6 % of cases. CONCLUSION: Flexible ureteroscopy and laser lithotripsies for upper urinary tract stones in neurologic patients with severe motor disability are associated with a lower success rate and some frequent low grade complications compared to overall population. In clinical practice, the indications of flexible ureterorenoscopy for these patients seem restricted. LEVEL OF EVIDENCE: 5.

Persistent low levels of serum hCG due to heterophilic mouse antibodies: an unrecognized pitfall in the diagnosis of trophoblastic disease.

Phantom hCG refers to persistent mild elevations of hCG, leading physicians to unnecessary treatments whereas neither a true hCG nor a trophoblastic disease is present. We report the case of a 23-year-old woman with persistent low levels of serum hCG detected one month after miscarriage. As choriocarcinoma was suspected, a chemotherapy trial of methotrexate was prescribed, without any hCG reduction. Subsequently, laparoscopy ruled out a trophoblastic residue and the patient was referred to the Endocrine Unit for further investigations. While low levels of hCG were still detected in serum, no hCG was detected in the urine. In addition, when serum was processed in a HBT tube for revealing heterophilic antibodies, hCG was no longer detected. Such finding indicated the presence of phantom hCG due to heterophilic mouse antibodies interaction. This case raises the need of clinico-biological discussion to avoid inappropriate therapeutic decisions. Based on this case experience and after review of the literature, we suggest that current gynecological protocols for the diagnosis and treatment of trophoblastic disease should consider the inclusion of urinary hCG and/or a test for serum heterophilic antibodies when appropriate.

[An overview of French nurses' habits: Long-term urinary catheterization]. / Sondage sur les sondages : us et coutumes des infirmiers en France.

INTRODUCTION: The lengthening of life expectancy associated with multiple comorbidities leads physicians and nurses to manage more and more patients with long-term urinary catheterization (LTUC). No recommendation is written about the management of LTUC patients. To assess the need to publish recommendations and tools to help nurses in a better management of LTUC, we conducted a survey of theoretical and practical knowledge of French nurses. MATERIALS AND METHODS: Epidemiological prospective study, type of practical studies in a declarative fashion, anonymous, made via computerized poll released on the website www.infirmiers.com. RESULTS: A total of 1254 registered nurses fulfilled the questionnaire. We observed a massive heterogeneity in different aspects of LTUC: local care and products used in them, urine bag change rhythm, lubrication of the catheter, respect of closed system, the rhythm of catheter change and in the management of blocked catheters. In total, 76% of nurses desire a theoretical and practical help for LTUC. CONCLUSION: We found a great diversity of knowledge and practices in terms of LTUC. In total, 40.67% of nurses realized at least a technical error during catheterization. To standardize the management of LTUC, we propose to draft recommendations under the aegis of the French Association of Urology. This will allow a better education of students, and providing online available support.

[Clinical evaluation of an obese person]. / La vignette diagnostique de l'etudiant. Mise au point d'un patient consultant pour obésité.

Obesity is increasingly prevalent in our society and medical consultations for evaluation and management of weight excess are frequent. Before considering a therapeutic strategy, a careful initial clinical assessment is mandatory. The diagnostic approach of an obese person should be similar as for any other chronic pathology. The objectives of the present clinical description are to report the main steps of an exhaustive anamnesis, the signs to be more specifically detected at the clinical examination and the other useful investigations to be programmed at first glance in a person who is visiting his/her medical doctor because of obesity. Based upon the data collected during this careful evaluation, therapeutic modalities may be defined, ideally in the frame of a multidisciplinary approach.

[Pancreas transplantation and venous thrombosis: multivariate analysis of risk factors]. / Transplantation pancréatique et thrombose veineuse : analyse multivariée des facteurs de risque.

OBJECTIVE: Portal veinous thrombosis (VT) in the pancreatic transplant (6 to 20% of the cases) is the first cause of early loss of the transplant. Our objective was to identify the risk factors of VT in our experiment. METHOD: The sample group includes 106 patients who underwent pancreas transplantation (portal venous drainage, enteric-drained pancreas) within our institute of transplantation from 2004 until 2010. We completed a portal vein extension graft in 25% of the cases. First of all, risk factors were selected from preoperative and operative data with an univariate analysis. We then carried out a multivariate analysis of these factors (binary logistic regression). The threshold P was 0.05. RESULTS: Sixteen patients (15%) showed a VT. Eight of them developed a total thrombosis and required a transplantectomy. Three risk factors of VT were isolated by the multivariate analysis: a BMI of the receiver>25kg/m(2) (Odds Ratio [OR]=6.977), a portal vein extension graft (OR=4.1) and an age of the donor>45 years (OR=4.432). CONCLUSIONS: The knowledge of these risk factors of thrombosis allows the implementation of preventive measures (selection of the donor, nutritional support of the receiver in the registration if BMI>25kg/m(2)). The portal lengthening should be avoided by an attentive retrieval of the transplant (without shorter section of the portal vein). Nevertheless, the presence of one of these risk factors in a transplant patient should lead to start an antithrombotic treatment.

[Bladder necrosis after an immediate post-operative mitomycin C instillation]. / Nécrose vésicale dans les suites d'une instillation postopératoire précoce (Ipop) de mitomycine C.

Administration of intravesical chemotherapy by mitomycin C decreases the risk of recurrence in non-muscle-invasive bladder tumours. We report the case of a man, who presented a full bladder necrosis after an immediate adjuvant mitomycin C instillation. The failure of resection of the necrotic area led us to perform a total cystectomy with an intestinal reconstruction. A review of the literature showed four other cases of necrosis of the bladder or of lower urinary tract. In all cases the rules of early instillation were observed.

[Active surveillance for prostate cancer: usefulness of endorectal MR at 1.5 Tesla with pelvic phased array coil in detecting significant tumors]. / Cancer de la prostate localisé: l'IRM endorectale à 1,5 Tesla améliore-t-elle la sélection des patients en vue d'une surveillance active?

PURPOSE: To describe and assess MRI signs of significant tumor in a series of patients who all underwent radical prostatectomy and also fulfilled criteria to choose active surveillance according to French "SurAcaP" protocol. PATIENTS AND METHODS: The clinical reports of 681 consecutive patients operated on for prostate cancer between 2002 and 2007 were reviewed retrospectively. All patients had endorectal MR (1.5 Tesla) with pelvic phased array coil. (1.5 T erMR PPA). Sixty-one patients (8.9%) fulfilled "SurAcaP" protocol criteria. Preoperative data (MR+core biopsy) were assessed by comparison to whole-mount step section pathology. RESULTS: 85.3% of the 61 patients entering SurAcaP protocol had significant tumor at pathology. (Non Organ Confined Disease (Non OCD)=8.2%, Gleason sum score>6=39.2%). A new exclusion criterion has been assessed: T3MRI±NPS>1 as a predictor tool of significant tumor. ("T3MRI±NPS>1"=Non OCD at MR±number of positive sextants involved in tumor at MR and/or Core Biopsy > to 1). Sensitivity, specificity, PPV, NPV of the criterion "T3MRI±NPS>1" in predicting significant tumor were, respectively: 77%, 33%, 86%, 20%. Adding this criterion to other criteria of the "SurAcaP" protocol could allow the exclusion of all Non OCD, and a decrease in Gleason sum Score>6 rates (20%). CONCLUSION: Endorectal MR at 1.5 Tesla with pelvic-phased array coil should be considered when selecting patients for active surveillance in the management of prostate cancer. A criterion based upon MR and core biopsy findings, called "T3MR±NSP>1" may represent an exclusion citeria due to its ability to predict significant tumor.

[Goldman Antopol syndrome associated with bilateral congenital severe factor V deficiency]. / Syndrome d'Antopol Goldman bilatéral associé à un déficit congénital sévère en facteur V.

Antopol-Goldman lesions are extremely rare. This kind of lesion is a subepithelial pelvic hematoma. This syndrome is certainly of rare occurrence and that is why a differential diagnosis of urothelial cancer in young patients who had problems with clotting must be raised. We reported a case of a 43-year-old haemophiliac with a severe congenital factor V deficit and presenting a bilateral and asynchronous Antopol Goldman syndrome. The diagnosis has been based on CT scans. The subepithelial aetiology bleeding has been shown on selective renal arteriography that allowed to cover a micro-aneurysm through the setting up of a vascular stent and a selective embolization.

[Adjustable Continence Therapy in women, middle term follow-up and a new technique for balloon positioning]. / Les ballonnets périurétraux ACT chez la femme : suivi à moyen terme et aide au positionnement.

OBJECTIVES: Evaluation of the results of Adjustable Continence Therapy (ACT) in women by a retrospective one-center study and exposure of a technique: bladder neck retrovision. PATIENTS AND METHODS: Between January 2001 and February 2009, 67 women had ACT implantation by the same surgeon for the indication of urinary incontinence by intrinsic sphincter deficiency, with mean age of 70.2 years. Mean follow-up was 24.8 months (1 to 89 months). Evaluation of functional results was realized with the research of urinary leakage when coughing or during abdominal thrust in the clinical exam, with the Urinary Symptom Profile (USP) questionnaire (since 2007), and with an analogical global satisfaction evaluation. RESULTS: More than 90% of women (n=67) have been improved at least at one medical consultation, and 60% (40/67) at last follow-up with a satisfaction index superior to 80% in 25 patients. Urinary leakage when coughing or doing abdominal thrust disappeared in 58% (36/62). An improvement of USP score was observed in 76% (19/25). Postoperative complications occurred in 37.3% (25 patients) with a mean period of 10.8 months after surgery. CONCLUSION: The ACT, indicated in stress urinary incontinence, is attractive because of the benefit-risk ratio. It could represent an alternative treatment when the artificial urinary sphincter is not technically possible, not accepted or when a reversibility is required. The bladder neck retrovision would improve the ACT surgery by precision and safety.

[Predictive factors and long term carcinogenic results of patients who no longer have residual tumors (stage pT0) on specimens of total cystectomy carried out for cancer of the bladder]. / Facteurs prédictifs et résultats carcinologiques à long terme des patients n'ayant plus de tumeur résiduelle (stade pT0) sur la pièce de cystectomie totale réalisée pour cancer de vessie.

AIM: The aim of our study was to evaluate predictive factors and long-term carcinogenic results for patients who had had a total cystectomy for cancer of the bladder and whose final histological results did not show evidence of a residual tumor. PATIENTS AND METHODS: From 1988 to 2002, 192 patients had a total cystectomy for a bladder tumor. No residual tumor (pT0) was evident in the specimens of cystectomy of 22 patients (11.5%). None of the patients had distant metastasis or ganglions at the time of the initial examination. RESULTS: Predictive factors for having no residual tumors based on the specimen of cystectomy (pT0) were an antecedent of neo-adjuvant chemotherapy (p=0.0079), an interval between the resection of the bladder and the cystectomy of more than 12 weeks (p=0.0014) and a resection of the initial bladder considered complete (p=0.0036). The average treatment of these 22 patients was 70+/-46 months. During treatment, two patients (9%) had a recurrence in the pelvis and 10 patients died including one from the development of his cancer of the bladder. Global, specific and non-recurrence survival at five years were 75%, 100% and 94%, respectively. We revealed better specific survival (p=0.0007) and without relapse (p<0.0001) in patients who no longer had a tumor on the specimen of cystectomy (pT0) compared with patients who had a residual tumor (pT+) but with no difference in global survival (p=0.0574). CONCLUSION: The absence of residual tumors (pT0) on a specimen of total cystectomy for cancer of the bladder was a good factor for prognosis regarding long-term survival even if tumor development was observed. Complete resection and neo-adjuvant chemotherapy probably played a beneficial role in the future of these patients.

[Parathyroid carcinoma: multicenter study of 17 patients]. / Carcinome parathyroïdien.

PURPOSE OF THE STUDY: To evaluate clinical characteristics and survival of patients treated for parathyroid carcinoma. STUDY DESIGN: A retrospective multicenter chart review of patients treated for parathyroid carcinoma between January 1979 and January 2005. RESULTS: 17 patients (10 women, 7 men) presenting with parathyroid carcinoma underwent surgical resection. Symptoms were largely related to hypercalcemia. Mean postoperative follow-up was seven years. Local recurrence was noted in four patients (24%) and three patients had late distant metastasis (18%). At the end of the study, nine patients were alive without evidence of recurrence (53%) and one patient was alive with recurrence at 5 years. Seven patients had died, four of whom died as a result of their parathyroid disease. CONCLUSION: Even when symptoms and findings are suggestive, the diagnosis of parathyroid carcinoma is oftentimes difficult. An adequate resection at the first intervention (complete tumor resection including a homolateral thyroid lobectomy and parathyroidectomy with resection of central lymph nodes) is recommended.

Transplant nephrectomy after graft failure: is it so risky? Impact on morbidity, mortality and alloimmunization.

PURPOSE: To determine the impact of transplant nephrectomy on morbidity and mortality and HLA immunization. METHODS: All patients who underwent transplant nephrectomy in our centre between 2000 and 2016 were included in this study. A total of 2822 renal transplantations and 180 transplant nephrectomies were performed during this period. RESULTS: The indications for transplant nephrectomy were graft intolerance syndrome: 47.2%, sepsis: 22.2%, vascular thrombosis: 15.5%, tumour: 8.3% and other 6.8%. Transplant nephrectomies were performed via an intracapsular approach in 61.7% of cases. The blood transfusion rate was 50%, the morbidity rate was 38% and the mortality rate was 3%. Transplant nephrectomies more than 12 months after renal transplant failure were associated with more complications (p = 0.006). Transfusions in the context of transplant nephrectomy had no significant impact on alloimmunization. CONCLUSION: The risk of bleeding, and therefore of transfusion, constitutes the major challenge of this surgery in patients eligible for retransplantation. Even if transfusions in this context of transplant nephrectomy had no significant impact on alloimmunization, this high-risk surgery, whenever possible, must be performed electively in a well-prepared patient.

[How to explore...the metabolic syndrome by its new IDF definition]. / Comment j'explore...le syndrome métabolique par sa nouvelle définition dite de "consensus".

The International Diabetes Federation recently proposed a so-called consensus definition of metabolic syndrome. According to this new definition, a subject has the metabolic syndrome if he/she has abdominal obesity (considered as a prerequisite and assessed, in the European population, by a waist circumference > 80 cm in women and > 94 cm in men) and, in addition, at least two other risk factors among 1) elevated fasting triglycerides > or = 150 mg/dl; 2) low HDL cholesterol HDL < 50 mg/dl in women and < 40 mg/dl in men; 3) increased arterial blood pressure > or = 130/ 85 mm Hg; and 4) elevated fasting plasma glucose concentration > or = 100 mg/dl. We will discuss the advantages and limitations of this new definition as well as the consequences of its use on the prevalence of the metabolic syndrome in the Belgian population.

[Pediatric psychiatry: evolution and developments]. / La psychiatrie infanto-juvénile evolution et développements.

Since 1986, the field of the child and adolescent clinics in the University Children Hospital Queen Fabiola is much developed. It is divided in five areas: the ambulatory sector, the medical psycho-psychiatry field, the day unit, the psychiatric hospitalisation and the ward. The population consists in babies (not yet born and born), children, adolescents. The clinical approach is multi and transdisciplinary including the child, his family and his life systems, caring staff included. Clinical research is centered on four axes: medical psychology, prevention, therapy and child psychiatry, somatic aspects included.