[A case of pyeloureteritis cystica: a diagnosis to keep in mind]. / La pyélo-urétérite kystique : un diagnostic à ne pas méconnaître.

The diagnosis of pyeloureteritis cystica is rare. Data from the literature about this disease are limited. Pyeloureteritis cystica is described as a benign inflammatory disease of the urinary tract, resulting from chronic inflammation of the urothelium. Radiologically, it is characterized by multiple rounded incomplete images of the urinary tract. The histology can confirm the diagnosis or eliminate differential diagnosis. We report the case of a pyeloureteritis cystica in a 64-year-old man, who had a chronic haematuria since ten years.

[Salvage radiotherapy outcomes for biochemical recurrence following radical prostatectomy among the African-Caribbean population of Guadeloupe]. / Résultats de la radiothérapie de rattrapage pour récidive biologique après prostatectomie radicale dans la population africaine-caribéene de la Guadeloupe.

OBJECTIVES: To make the first analysis of the salvage radiotherapy outcomes for biochemical recurrence of prostate cancer after radical prostatectomy in African descendant people, witch has no healthcare access difficulties: the French West-Indies African-Caribbean people of Guadeloupe. PATIENTS AND METHOD: Ninety successive patients, with biological failure after radical prostatectomies were treated in the University Hospital of Pointe-à-Pitre with salvage radiotherapy between April 2003 and December 2008. The retrospective study analysed the biochemical disease free survival (bDFs) after irradiation with Kaplan-Meier method, and the independent predictors of bDFs using the Cox model, with P<0.05. The treatment failure was defined for PSA superior or equal to nadir +0.1 ng/mL. RESULTS: The median dose was 64 Gy. At the median follow-up of 24.63 months, 35 (38.9%) patients had biochemical recurrence. The median bDFs was 55.3 months, the bDFs probabilities at months 12, 24, 36 and 48 were 8.1%, 70.3%, 61.9% and 56.1%. Multivariate analysis determined that the independents predictors of treatment failure were the seminals vesicles invasion (P=0.0094, Hazard ratio=2.63 CI 95%: [1.28-5.55]), the PSA velocity superior or equal to 0.75 ng/mL per year (P=0.0002, Hazard ratio=3.88 CI95%: [1.86-7.75]) and the pre-irradiation PSA level superior or equal to 1.5 ng/mL (P=0.0093, Hazard ratio=2.89 CI95%: [1.30-6.45]). CONCLUSION: Salvage radiotherapy for African descendent people with no healthcare difficulty access was an efficient treatment for the biochemical recurrence and had the same outcomes than others Caucasian people.

[Evaluation of sexuality among Afro-Caribbean patients homozygous SS sickle cell disease followed in Martinique]. / Évaluation de la sexualité chez les patients afro-caribéens drépanocytaires homozygotes SS suivis en Martinique.

OBJECTIVES: To evaluate and compare retrospectively the sexuality of homozygous sickle cell patients from Martinique related to priapismic events using the IIEF-15 questionnary. PATIENTS AND METHODS: Retrospective survey of 68 patients with sickle cell disease regularly followed up at sickle cell disease's center of Lamentin's hospital according to the occurrence and the type of priapism (intermittent or acute). We shared patients in three groups: no priapism (group 1), intermittent priapism (group 2) and acute priapism (group 3). Information regarding specific and preventive treatments to the disease, and events related to priapism have been gathered for all patients. Each patient's sexuality has been studied with the IIEF-15 questionnary and results have been compared between the groups to show the priapism's impact on sexual activity of these young men. RESULTS: In 37.3%, priapism was observed. The group 1 and 2 had better results than the group 3 on the EF score. There was no significative difference between the group 1 and 2. There was also no significative difference between the three groups on the SD, FO, IS and OS score. The increase of the priapism duration and the repetition of the episodes were associated to a decrease of the EF score. CONCLUSION: Our study showed the lack of major impairment of erectile function in patients with intermittent priapism in opposition to the patients with acute priapism.

[Radiotherapy with androgen deprivation in high-risk prostate cancer: what outcomes on a Caribbean population?]. / Radiohormonothérapie dans le cancer de la prostate à haut risque : quels résultats sur une population Antillaise ?

OBJECTIVE: To analyze in a Caribbean population at 90% of African descent, the results of radiotherapy with androgen deprivation (AD) in high-risk prostate cancer (PCa). PATIENTS AND METHODS: Fifty-nine consecutive patients with a high-risk PCa as defined by the D'AMICO classification and treated by radiotherapy with AD between January 2003 and April 2009 in our center were analyzed. The median dose of radiation and the median duration of AD were 70Gy and 37months respectively. Biochemical recurrence (BF), as primary outcome was defined according to the PHOENIX criteria (nadir PSA+2ng/mL). Multivariate analysis was performed to identify predictive factors of BF. The median follow-up was 47months. RESULTS: Eight (13.6%) patients had BF and four (6.8%) developed metastases. Six (10.2%) died during the follow-up. The 5years acturial biochemical disease-free survival was 79.7%. Multivariate analyses have shown that Gleason sum (GS) superior to 7 (P=0.029), AD duration less than 24months (P=0.004) and the rate of Nadir PSA greater or equal to 0.5ng/mL (P=0.011) were independent predictive factors of BF. CONCLUSION: This study was the first to our knowledge, to provide that radiotherapy associate with AD for HRPC among Caribbean men is effective as observed in other populations. Patients with GS superior to 7 could be considered for more aggressive treatments in clinical trials.

[A technique of continent vesicostomy with ileocystoplasty: study of 32 patients]. / Une technique modifiée de cystostomie continente avec iléocystoplastie d'agrandissement : à propos d'une série de 32 patients.

OBJECTIVES: To evaluate the functional outcomes and quality of life of adult's disabled motor with neurogenic bladders, who had undergone a continent catheterizable vesicostomy with ileocystoplasty permitting a systematic implantation of the stoma at the umbilicus without closure of the bladder neck. METHODS: Between 2004 and 2006, 32 adults with neurogenic bladder who underwent Mitrofanoff continent catheterizable vesicostomy with ileocystoplasty were evaluated with the "Qualiveen" and a local satisfaction questionnaire. The median age was 42.2 years. The neurological diagnoses were: spinal cord injury (26), spina bifida (two) and multiple sclerosis (four). The cystostomies were conducted with appendix (17) and the ileum according Monti's technique (15). The stomas were conducted in 29 cases at the umbilicus. RESULTS: The 31 patients were followed up for a mean of 21.6 months. The continence rate was 86%. The satisfaction with functional result and aesthetic of the stoma was of 88% and 92%. Capacity to self catheterize increased from 64% to 88%. Thirty-three percent of stoma stenosis was noted and 36% of patients underwent a reintervention including 25% for stenosis. CONCLUSION: The results of this study have demonstrated that the ileocystoplasty with umbilical continent vesicostomy fullfill with treatment objective's of patients with neurogenic bladder: restoration of continence and improved quality of life by granting them social life.

How Tissue Mechanical Properties Affect Enteric Neural Crest Cell Migration.

Neural crest cells (NCCs) are a population of multipotent cells that migrate extensively during vertebrate development. Alterations to neural crest ontogenesis cause several diseases, including cancers and congenital defects, such as Hirschprung disease, which results from incomplete colonization of the colon by enteric NCCs (ENCCs). We investigated the influence of the stiffness and structure of the environment on ENCC migration in vitro and during colonization of the gastrointestinal tract in chicken and mouse embryos. We showed using tensile stretching and atomic force microscopy (AFM) that the mesenchyme of the gut was initially soft but gradually stiffened during the period of ENCC colonization. Second-harmonic generation (SHG) microscopy revealed that this stiffening was associated with a gradual organization and enrichment of collagen fibers in the developing gut. Ex-vivo 2D cell migration assays showed that ENCCs migrated on substrates with very low levels of stiffness. In 3D collagen gels, the speed of the ENCC migratory front decreased with increasing gel stiffness, whereas no correlation was found between porosity and ENCC migration behavior. Metalloprotease inhibition experiments showed that ENCCs actively degraded collagen in order to progress. These results shed light on the role of the mechanical properties of tissues in ENCC migration during development.

A new locus for arrhythmogenic right ventricular cardiomyopathy (ARVD2) maps to chromosome 1q42-q43.

Autosomal dominant arrhythmogenic right ventricular cardiomyopathy (ARVD, MIM 107970) is one of the major causes of juvenile sudden death. We have previously assigned the disease locus to chromosome 14q23-q24. Here we report on a novel variant of ARVD, which is transmitted associated to 1q42-q43 and is characterized by a concealed form, showing effort-induced polymorphic tachycardias. Since both loci ARVD1 and ARVD2 map in proximity of alpha-actinin genes, the possible implication of these myofibrillar proteins in the pathogenesis of ARVD is discussed. Two additional ARVD families, tested with markers of chromosomes 1q42-q43 and 14q23-q24, failed to show linkage, providing evidence of further genetic heterogeneity.