Uretero-arterial fistula: Six new cases and systematic review of the literature.

AIM: Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS: Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS: Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION: SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF: 3.

Overall survival and oncological outcomes after partial nephrectomy and radical nephrectomy for cT2a renal tumors: A collaborative international study from the French kidney cancer research network UroCCR.

BACKGROUND: Partial nephrectomy (PN) is recommended as first-line treatment for cT1 stage kidney tumors because of a better renal function and probably a better overall survival than radical nephrectomy (RN). For larger tumors, PN has a controversial position due to lack of evidence showing good cancer control. The aim of this study was to compare the results of PN and RN in cT2a stage on overall survival and oncological results. METHOD: A retrospective international multicenter study was conducted in the frame of the French kidney cancer research network (UroCCR). We considered all patients aged≥18 years who underwent surgical treatment for localized renal cell carcinoma (RCC) stage cT2a (7.1-10cm) between 2000 and 2014. Cox and Fine-Gray models were performed to analyze overall survival (OS), cancer specific survival (CSS) and cancer-free survival (CFS). Comparison between PN and RN was realized after an adjustment by propensity score considering predefined confounding factors: age, sex, tumor size, pT stage of the TNM classification, histological type, ISUP grade, ASA score. RESULTS: A total of 267 patients were included. OS at 3 and 5 years was 93.6% and 78.7% after PN and 88.0% and 76.2% after RN, respectively. CSS at 3 and 5 years was 95.4% and 80.2% after PN and 91.0% and 85.0% after RN. No significant difference between groups was found after propensity score adjustment for OS (HR 0.87, 95% CI: 0.37-2.05, P=0.75), CSS (HR 0.52, 95% CI: 0.18-1.54, P=0.24) and CFS (HR 1.02, 95% CI: 0.50-2.09, P=0.96). CONCLUSION: PN seems equivalent to RN for OS, CSS and CFS in cT2a stage kidney tumors. The risk of recurrence is probably more related to prognostic factors than the surgical technique. The decision to perform a PN should depend on technical feasibility rather than tumor size, both to imperative and elective situation. LEVEL OF EVIDENCE: 4.

Study of the role of interleukin-6 and highly sensitive C-reactive protein in diabetic nephropathy in type 1 diabetic patients.

BACKGROUND: Diabetes Mellitus (DM) is becoming an increasingly common disease which is the leading cause of chronic renal failure. The pathogenesis of diabetic nephropathy is still a matter of debate. There are conflicting results regarding the relation of C reactive protein (CRP), interleukin-6 (IL-6) and diabetic nephropathy in type 1 diabetes. OBJECTIVES: This study was aiming to determine the association between higly sensitive (Hs)-CRP and IL6 with nephropathy in a sample of type 1 diabetic Egyptian patients. MATERIALS AND METHODS: The study was conducted on forty type-1 diabetic patients (Group I), who subdivided into three subgroups according to their urine albumin excretion rate (AER); Group IA: 10 patients with AER <20 microg/min, Group IB: 15 patients with AER ranges from 20-200 microg/min. Group IC: 15 patients with AER is > 200 microg/min and 10 healthy subjects as a control (Group II). RESULTS: There were high statistical significant difference (p < 0.001) between group I with group II regarding HsCRP (4.39 +/- 1.94, 1.32 +/- 0.39), and IL-6 (2.82 +/- 0.76, 1.95 +/- 0.35). In group I, we found a positive significant correlation (p < 0 .001) between UAE and levels of Hs-CRP (r = 0.927), and IL-6 (r = 0.838), respectively. Also, a positive significant correlation between Hs-CRP and IL-6 (r = 0.728, p < 0.001) was found. Fasting plasma glucose (FPG) level and HbA1c showed a significant positive correlation (p < 0.001) with Hs-CRP (r = 0.531) (r = 0.750), and IL-6 (r = 0. 490) (r = 0.680) respectively. CONCLUSION: Hs-CRP and IL-6 are sensitive markers for diabetic nephropathy predicting its progression and severity in type 1 diabetics.

[Endoscopy in the diagnosis of diseases of the esophagus, stomach and duodenum]. / Endoskopiia v diagnostike zabolevanii pishchevoda, zheludka i dvenadtsatiperstnoi kishki

The results of endoscopic studies in 948 patients with various diseases of the upper digestive tract are reported. It is the author's opinion that esophago-gastrointestinal endoscopy is the most informative method of diagnosing diseases of the esophagus, stomach and duodenum.