[Neoadjuvant chemotherapy in muscular invasive bladder cancer: Complications and consequences with cystectomy]. / Chimiothérapie néoadjuvante dans le cancer de vessie infiltrant le muscle : complications et conséquences sur la réalisation de la cystectomie.

INTRODUCTION: The fear of the deterioration of the patient's condition related to the toxicity of neoadjuvant chemotherapy is a barrier to its development. This multicenter retrospective study aims to present the secondary effects of neoadjuvant chemotherapy and its impact on the achievement of cystectomy. MATERIALS AND METHODS: Patients with urothelial carcinoma classified cT2 to cT4a N0M0 were included. Chemotherapy with 6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) followed by a cysto-prostatectomy or anterior pelvectomy was scheduled. RESULTS: A total 32 patients were included. Six cycles of neoadjuvant chemotherapy were performed in all 11 patients. Shutdown causes were toxicity in 85% of cases. Cystectomy was performed in 86.6% of patients. Surgery was not performed in 6 patients. The reasons were the alteration of the general condition in 2 cases, 2 patients had advanced cancers diagnosed intraoperatively, and 2 refused surgery. Complications of grades 3 and 4 according to the classification of Clavien and Dindo had occurred respectively in 15.3% and 11.5%. DISCUSSION: This study reports results close to what is found in the literature on the effects of neoadjuvant chemotherapy on achieving cystectomy, but it has some limitations: the retrospective analysis of data on surgery and the lack of control group. In addition, the short follow-up does not yet allow to know the long-term oncological results. CONCLUSION: This study supports the fact that the toxicity of neoadjuvant chemotherapy does not seem to cause a significant risk of non-completion of cystectomy. LEVEL OF EVIDENCE: 4.

Twenty-year experience with jejunal conduits.

OBJECTIVES: To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. METHODS: From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop (10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. RESULTS: Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. CONCLUSIONS: Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.

[Augmentation ileocystoplasty in neurologic bladder]. / L'iléocystoplastie d'agrandissement dans les vessies neurologiques.

OBJECTIVE: The authors evaluated the results of augmentation ileocystoplasty in patients presenting with neurogenic urinary incontinence. MATERIALS AND METHODS: A prospective study was conducted in 36 patients (25 women, 11 men) 30 of whom simultaneously underwent a bladder neck continence procedure. The mean follow-up was 32.2 months. RESULTS: Daytime continence was obtained in 32 patients (88.8%). Thirty patients (83.3%) were continent a night. The upper urinary tract did not deteriorate. One patient developed bladder stones and 2 presented a vesical perforation. Urodynamic studies showed an increased functional bladder capacity and compliance (p < 0.001) and loss of uninhibited bladder contractions. CONCLUSION: Augmentation ileocystoplasty is an effective and reliable surgical procedure after failure of conservative management. However, long-term complications can occur and regular surveillance is necessary.

[Risk of accidental contamination by the human immunodeficiency virus (HIV): review and management]. / Risques de contamination accidentelle par le virus de l'immuno-déficience humaine (VIH): mise au point et conduite à tenir.

In surgery practice, everyone must know what to do in case of injury with exposure to body fluids. The chimioprophylactic treatment has to be easy to take in case of high risk of VIH transmission. To prevent these accident, surgery on infected people must always be done by surgeon who have experience.

Assessment of trace metal contamination in mangrove ecosystems from Senegal, West Africa.

The inorganic contamination of sediment and harvested molluscs was investigated in the mangrove environment of Southern West Senegal. Trace metals were analysed in surface sediments, two bivalves (Arca senilis and Crassostera gasar) and three gastropods (Conus spp., Hexaplex duplex and Pugilina morio) collected from four stations: Dionewar, Niodor and Falia localised in the Saloum Delta, and Fadiouth from the Petite Côte. A geochemical normalisation approach by using aluminium allowed for discrimination of sediment contamination among sites. Indeed, Fadiouth appeared highly contaminated with Cd, Hg and Ni compared to the Saloum Delta. For all mangrove sites, trace metals exhibited significant higher concentrations (on a dry weight basis) in shellfish compared to sediments, excepted for Ni and Pb. The distribution pattern followed a similar global trend in molluscs regardless of the spatio-temporal variability, with the predominance of Zn (80% of total metals) followed by Cu and Cd. However, strong differences of metal bioavailability and bioaccumulation in biota were demonstrated, revealing the requirement of employing a suite of organism bioindicators to monitor metal contamination in mangrove ecosystems. From an ecotoxicological point of view, trace metal levels in sediments from the Petite Côte and the Sine-Saloum Estuary were below the effects range-low (ERL) threshold limit of the sediment quality guidelines for adverse biological effects (SQGs). On the opposite, some concerns about Cd contamination of edible shellfish from Southern West Senegal were highlighted, from both the safety point of view of local populations' health, and the chemical quality point of view of exported resources.