Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community-based study.

BACKGROUND: The incidence of superficial vein thrombosis (SVT) in the general adult population remains unknown. OBJECTIVES: To assess the annual diagnosis rate of symptomatic, objectively confirmed lower limb SVT, associated or not with concomitant deep vein thrombosis and/or symptomatic pulmonary embolism. METHODS/PATIENTS: We conducted, from November 14, 2011, to November 13, 2012, a multicenter, community-based study in the Saint-Etienne urban area, France, representing a population of 265 687 adult residents (according to the 2009 census). All 248 general practitioners located within the area were asked to refer any patient with clinically suspected lower limb acute SVT to a vascular physician for systematic compression ultrasonography. All 28 vascular physicians located within the area participated in the study. The annual diagnosis rate, with the corresponding 95% confidence interval (CI), was calculated as the number of patients with symptomatic, objectively confirmed SVT divided by the number of person-years at risk defined by population data of the area. All venous thromboembolic events were validated by an independent central adjudication committee. RESULTS: Overall, 171 patients with symptomatic, confirmed SVT were reported. The annual diagnosis rate was 0.64& (95% CI, 0.55%-0.74&), was higher in women, and increased with advancing age regardless of gender [corrected]. Concomitant deep vein thrombosis (20 proximal) was observed in 42 patients (24.6% [95% CI, 18.3%-31.7%]), and concomitant symptomatic pulmonary embolism was observed in eight patients (4.7% [95% CI, 2.0%-9.0%]). CONCLUSIONS: This first community-based study showed that symptomatic SVT with confirmed diagnosis is a relatively common disease frequently associated with thromboembolic events in the deep venous system.

[Anterior sacral meningocele with urologic manifestations. Report of 3 cases]. / Méningocèle sacrée antérieure à expression urologique. A propos de 3 observations.

Anterior sacral meningocele is defined as a spinal fluid-filled thecal sac in the pelvis communicating with the spinal subarachnoid space through a defect in the anterior sacral wall. Since scimitar shape of the sacrum is characteristic, diagnosis is easily confirmed by echography and myelography. The sac very often contains benign tumors and a thickened filum terminale which can achieve a tethered cord syndrome. This congenital malformation, whose autosomal inherited condition has been proposed, has usually few characteristic symptoms but can present itself as a neurogenic bladder from tethered cord origin. Neurosurgical treatment can prevent rupture of the meningocele with meningitis. In addition to symptomatic treatment of the neurogenic bladder, the urologist must advise neurosurgical operation to preserve potency and cure specific bladder dysfunction secondary to tethered cord syndrome.

[Major urological cancer excisions after the age of 75]. / Les exérèses urologiques majeures pour cancer après 75 ans.

32 patients more than 75 years old had major surgical procedures for urologic neoplasms: radical nephrectomy for renal cell cancer (9 cases), nephroureterectomy for upper urinary tract tumor (3 cases), radical cystectomy for invasive bladder cancer (20 cases). Postoperative mortality was 12.5%. In the nephrectomy group, 3 palliative procedures gave a mean survival time of 7 months. On 9 curative procedures, 7 patients are alive and free of disease with a mean follow-up of 45.6 months. In the cystectomy group, 5 palliative procedures gave a mean survival time of 7 months. On 15 curative procedures, 6 patients are alive and free of disease with a mean follow-up of 18.6 months. Our data confirm that curative procedures can be performed in the elderly. Mean survival time and quality of life after palliative procedures suggest that only true comfort procedures have to be performed.

[Resection of pyelo-ureteral junction without external urinary drainage for primary ureteral stenosis]. / Résection de jonction pyélo-urétérale pour sténose primitive sans drainage urinaire externe.

During a 3-year period 30 consecutive patients (20 women and 10 men) with primary ureteropelvic junction obstruction underwent open dismembered pyeloplasty associated with the placement of an indwelling double pigtail stent via antegrade approach. Renal stones were removed in 8 cases, multiple nephrotomies being necessary in 2 patients. 2 men had temporary urinary leakage. Mean hospitalization time after surgical procedure was 9,8 days, but last 18 patients were discharged after only 7,3 days, Stents were removed 4 to 5 weeks after operation. With 1 to 4 years post-operative follow-up, successful treatment with relief of obstruction was achieved in all 38 patients without secondary stricture. Open pyeloplasty with double pigtail stenting appears to be a safe and successful procedure for the treatment of primary ureteropelvic junction obstruction in adults. Comparison with percutaneous endopyelotomy in terms of morbidity, duration of hospitalization and success rate appears to be in favor of open procedure, although secondary stricture may require endourological procedure.