The accuracy of renal tumor biopsy: analysis from a national prospective study.

OBJECTIVE: To assess preoperative renal tumor biopsy (RTB) accuracy. MATERIALS AND METHODS: As part of the prospective NEPHRON study, data from 1,237 renal tumors were collected, including the use and results of RTB and final histology following nephrectomy. During the 6 months period of inclusion, 130 preoperative biopsies were performed. We used the kappa coefficient of the McNemar test to determine the concordance between the biopsy and the nephrectomy specimen (NS) regarding four parameters: malignant/benign status, histological subtype, Fuhrman grade and microscopic necrosis. RESULTS: Preoperative biopsies were performed in 9.7 and 11.4 % of the 667 radical and 570 partial nephrectomies, respectively. Tumor biopsy was inconclusive in 7.7 % of the cases. In 117 cases, a comparison between RTB and NS was available. Benign tumors accounted for three (2.6 %) and five (4.3 %) of the RTB and NS, respectively (κ = 0.769, good). With seven (6 %) discordant results in terms of histological subtype characterization between RTB and final pathology, RTB accuracy was considered excellent (κ = 0.882). In 33 cases (31.7 %), Fuhrman grade was underestimated at biopsy resulting in an intermediate concordance level (κ = 0.498). Tumor microscopic necrosis was identified in 12 RTB (10.4 %) versus 33 NS (28.4 %) (κ = 0.357, poor). CONCLUSIONS: RTB provides good to excellent diagnostic performance for discriminating malignancy and tumor histological subtype. However, its performance is intermediate or even poor when considering prognostic criteria like Fuhrman grade or microscopic necrosis. Thus, this possible inaccuracy should be taken into consideration when using RTB for accurate guidance of treatment strategy.

[Are there any factors predicting failure or complications rates of trans-obturator surgery for stress urinary incontinence?]. / Existe-t-il des facteurs prédictifs d'échec ou de complications dans la chirurgie de l'incontinence urinaire d'effort par voie transobturatrice?

OBJECTIVE: Since 2001 and the publication by Delorme of the trans-obturator route in the stress urinary incontinence (SUI), this technique has known an increasing development in France. The aim of this study is to evaluate the impact of different predicting factors on results and complications of trans-obturator surgery. PATIENTS AND METHODS: It is a retrospective, multicentric study, including 4 centers, 14 surgeons and 196 patients operated between February 2003 and August 2005. We have realized a univariate (Chi2 test) and multivariate (logistic regression test) statistic analysis concerning 7 sub-groups defined according to the literature on the TVT. RESULTS: Age>55 years (P=0,044) and SUI grade>2 (P=0,028) are statistically associated with a decrease of surgical success, age>55 years is also associated with an increase of complications rate in univariate (P=0,033) and multivariate (P=0,048) analysis. DISCUSSION AND CONCLUSION: Age>55 years should be considered, according to us, as a risk factor of surgical failure and complications in the trans-obturator surgery for SUI, none of the others risk factors found in the literature on the TVT seems to have an influence, in this study, on the results of trans-obturator surgery for SUI.

[Surgical treatment for ureteropelvic junction syndrome in infants and children (report of 73 cases)]. / Le traitement chirurgical du syndrome de la jonction pyélo-urétérale chez le nourrisson et l'enfant (à propos de 73 observations).

between 1982 and 1990, 73 children were operated for pyeloureteric junction syndrome (76 pyeloplasties). The authors distinguish between a group of 45 infants operated before the age of 2 years and a group of 35 children operated after the age of 2 years. 40% of these cases had been detected antenatally, which modified the management and treatment of these infants, operated at about the age of 6 months (mean: 6.6 months). Treatment was conservative (one nephrectomy out of the 41 infants operated: 2.4%). Pyeloplasty was performed according to the Anderson-Hynes-Küss resection-anastomosis technique under an operating magnifying glass. Early surgery offers the best chance of recovery. Urinary tract drainage was not systematic in these infants (50% of cases) and did not affect the long term results. Early complications and surgical revisions (3.9%) were not more frequent in the infants operated earlier. The definitive results were good in 88.5% of cases, while 7.2% of cases required further surveillance. Renal parenchymal lesions (4.3%) were related more to pyelonephritis than to failure of surgery. Overall, a conservative surgical approach is recommended, except in minor syndromes which require rigorous surveillance.

[Histologic identification of the afferent fibers of the pelvic plexus]. / Identification histologique des afférences du plexus pelvien.

The inferior hypogastric (pelvic) plexus conveys two types of fibres: sympathetic fibres originating in the thoracolumbar sympathetic chain and parasympathetic fibers originating in the sacral anterior rami. By using a histofluorescent stain (glyoxalic acid) and a histochemical stain (thiocholine) in 17 fresh cadavres, we have demonstrated that the sympathetic fibres arise from sacral sympathetic ganglia. These fibres participate in the constitution of the pelvic splanchnic nerves. In this study, we confirm that the inferior roots of the pelvic plexus are not only parasympathetic, but also sympathetic.

[Reconstruction of the penile skin in Fourier's gangrene: the use of a helical skin graft]. / La reconstruction du fourreau de la verge dans la maladie de Fournier: utilisation d'une greffe cutanée en hélice.

The emergency treatment of Fournier's and perineal gangrene is now well defined and is based on excision of the necrotic tissues and broad spectrum antibiotics combined with hyperbarid oxygen therapy and symptomatic resuscitation measures. However, several procedures have been described for the reconstruction of the excised zones. In the light of one case of Fournier's gangrene, the authors evaluate reconstruction of the penile skin by means of a helical split-skin graft. With a follow-up of one year, the morphological and functional result was excellent. The patient has normal erection and the suture line does not contain any retractile adhesions. The authors therefore consider that this simple, but little known procedure should be part of the urologist's therapeutic arsenal for reconstruction of the penile skin.

Intrinsic low temperature paramagnetism in B-DNA.

We present an experimental study of magnetization in lambda-DNA in conjunction with structural measurements. The results show the surprising interplay between the molecular structures and their magnetic property. In the B-DNA state, lambda-DNA exhibits paramagnetic behavior below 20 K that is nonlinear in an applied magnetic field whereas, in the A-DNA state, it remains diamagnetic down to 2 K. We propose orbital paramagnetism as the origin of the observed phenomena and discuss its relation to the existence of long range coherent transport in B-DNA at low temperature.

[Treatment of calculi to the terminal ureter by extracorporeal piezoelectric lithotripsy. First experiment in Grenoble]. / Le traitement des calculs de l'uretère terminal par lithotritie piézo-électrique extra-corporelle. Première experience grenobloise.

Piezo-electric shock wave lithotripsy was successfully performed in 20 patients out of 25 presenting with distal ureteral stones. Echographic adjustment of the stone remains the very most important point of the technique. The treatment is non invasive, doesn't require any in-hospital stay and displays good tolerance.

[Prostatic utricle in adults. Report of 4 cases]. / L'utricle prostatique de l'adulte. A propos de 4 cas.

We present here four cases of adult prostatic utricules, and discuss the endoscopic or surgical treatment. A brief embryological and clinical summary allows a better understanding of this malformation. Therapeutic indications are reviewed and transtrigonal approach is described. We think that this surgical procedure gives better results and less morbidity.

[The enthesopathic shoulder]. / L'épaule enthésopathique.

61 shoulders of rheumatoid diseases, 23 of ankylosing spondylo-arthritis, 22 of psoriatic rheumatism and 30 of hyperostoses (Forestier's disease) were analysed and compared. There is a very significant difference between rheumatoid disease, on the one hand, and the other diseases, on the other hand. In ankylosing spondylo-arthritis, psoriatic rheumatism and hyperostosis, enthesophytes are observed; it is not the case in rheumatoid disease (unless associated with hyperostosis). The most frequent entesophyte is the one at the acromial insertion of the acromio-coracoid ligament ("bearded acromion"). It is also the easiest to visualise on an AP X-Ray of the shoulders. The association of a bearded acromion and an ulceration of the supero-lateral area of the humeral head (sulcus) is characteristic of spondylo-arthropathies (ankylosing spondylo-arthritis, psoriatic rheumatism) and is not found in hyperostosis. The ulceration of the sulcus is, on the contrary, common to spondylo-arthropathies and rheumatoid disease. This ulceration does not seem to be the sign of an inflammatory enthesopathy but rather a synovitis.

[Multiorgan procurement (MPO). Who? How? What results?]. / Le prélèvement multi-organe (PMO). Qui? Comment? Quels résultats?

Between 1985 and 1988, 156 organs were harvested using a multiorgan procurement technique (MPO) in the Urology Dept of Grenoble University Hospital (50 MOP). All the organs transplanted either in Grenoble or in other centers have been followed up after transplantation to try to appreciate their value and function. The surgical procedure is described, and results, organ by organ, are given. The conclusion is that the MOP technique is perfectly usable and reliable without jeopardizing any of the transplanted organs.

Two-gap state density in MgB(2): a true bulk property or a proximity effect?

We report on the temperature dependence of the quasiparticle density of states in the simple binary compound MgB(2) directly measured using scanning tunneling microscope (STM). To achieve high quality tunneling conditions, a small crystal of MgB(2) is used as a tip in the STM experiment. The "sample" is chosen to be a 2H- NbSe(2) single crystal presenting an atomically flat surface. At low temperature the tunneling conductance spectra show a gap at the Fermi energy followed by two well-pronounced conductance peaks on each side. They appear at voltages V(S) approximately +/-3.8 mV and V(L) approximately +/-7.8 mV. With rising temperature both peaks disappear at the T(C) of the bulk MgB(2), a behavior consistent with the model of two-gap superconductivity. The possibility of a particular proximity effect is also discussed.