The lactation consultant as expert witness.

Several factors contributed to the impact of Ms. Scott's testimony on the judge and thereby on the case. Most obvious was the degree of her expertise; just as important was the way in which she presented her testimony. She maintained a moderate tone throughout and never gave the impression that what she was saying was anything but mainstream or that she was speaking from zealotry. Her greatest strength, as for any LC's testimony, is that she spoke in terms of what was best for the child. In any initial custody case the judge must decide what is in the child's best interests or some small variation on that theme. By its very nature, breastfeeding and all the information provided about it speaks to the same issue. In that sense, the testimony is not offered on behalf of one of the parents, but on behalf of the welfare of the child. It is this nonpartisan aspect of an LC's testimony that can make it so powerful.

[Tendinopathy and fluoroquinolones]. / Tendinopathies et fluoroquinolones.

Tendinopathies, essentially involving the Achilles tendon, which tendon rupture, can be secondary to treatment with fluoroquinolones, and facilitated by corticosteroid therapy, renal failure and sport. Fluoroquinolone treatment must therefore be prescribed cautiously and patients must be advised to stop treatment at the slightest warning signs of tendinitis.

[Intestinal urinary fistulas of renal and pelvis origin]. / Fistules entéro-urinaires d'origine rénale et pyélique.

As the authors point out the uncommon occurrence of these fistulas between the calicopyelic cavities with the colon, the duodenum and still more unusually with the stomach and the jejunum, they report the etiological and clinical features found in the published cases. Usually the only solution is a nephrectomy.

[Uretero-intestinal fistulas]. / Fistules urétéro-intestinales.

Reporting their experience of these seldom described fistulas, the authors specify their etiological modalities, mainly the infected stones, the multiple clinical symptomatology and specify the various locations between the ureter and the enteral duct from the duodenum to the anal channel at any point.

[Vesico-intestinal fistulas]. / Fistules vésico-entérales.

The authors report the various locations (ileal, appendicular, colic, rectal and through Meckel diverticulum) of the fistulas between the bladder and the digestive tract and specify the mainly inflammatory etiologies and specifically those due to the Crohn disease or those caused by tumors aggravated by irradiation and repeated surgery.

[Uro-intestinal fistulas of cancerous origin]. / Fistules uro-digestives d'origine cancéreuse.

Malignant entero-vesical fistulas are uncommon. Colonic malignancy is the main cause although fistula are present in just 1%. Pneumaturia and fecaluria are pathognomonic for entero-vesico-fistula and are present in half of cases. By combining the results of cystoscopy, barium enema and urine culture, fistula can be identified in almost all the cases. Escherichia coli, Streptococcus faecalis and Proteus mirabilis are very often isolated from the urine cultures. The management of entero-vesical-fistula depends of the etiology. The treatment requires in most of the case resection of the diseased bowel with partial cystectomy and primary anastomosis. But sometimes, is necessary to perform a diverting colostomy and urinary diversion.

[Bladder leiomyomas and fibromas. Apropos of 8 cases]. / Léiomyomes et fibromes vésicaux. A propos de huit cas.

Eight cases of benign mesothelial tumors of the bladder are reviewed (7 leiomyomas and 1 fibroma). The authors describe the pathological and clinical features and the various possibilities of diagnosis of these uncommon tumors. The treatment is exclusively surgical and the prognosis is good in every case.

[Unusual tumors of the testis. Apropos of 22 cases]. / Les tumeurs rares du testicule. A propos de vingt-deux cas.

The authors report their experience of rare non-germ-cell tumours of the testis over a period of 10 years. The criteria of benign disease, justifying testicular preservation in 5 out of 7 cases of epidermoid cysts, are defined. Four cases of Leydig cell tumours, including 3 with gynaecomastia, are described. Three cases of adenomatoid tumours with conservative surgery, 3 lymphomas, 2 mature teratomas and 2 cysts of the rete testis are also reported. The place of ultrasonography is defined and the possibility of conservative surgery is discussed in relation to a review of the recent literature.

[Prostatic or urethral rectal fistulas]. / Fistules prostato-ou uréthro-rectales.

Reporting 7 new observations of prostatic or urethro-rectal fistulas, the authors insist on their etiological modalities specially of traumatical, inflammatory, post-irradiation, cancerous and congenital origin. The diagnosis methods and surgical techniques are also mentioned.

[[Multilocular solitary renal cyst. 2 adult case reports with review of the literature]. / Kyste multiloculaire solitaire rénal. A propos de 2 cas chez l'adulte avec revue de la littérature.

The authors report 2 cases of renal multilocular cyst and review 250 cases reported in the literature, revealing the original features of this benign tumour which has an equal incidence in children and adults with a controversial acquired or malformative aetiopathogenesis, precise histological features, but a difficult preoperative and intraoperative diagnosis despite modern imaging techniques. In the great majority of cases, treatment consists of nephrectomy.

[Regression and disappearance of bone metastasis in a case of prostatic carcinoma after bilateral orchidectomy and oestrogen therapy (author's transl)]. / Régressions et disparitions de métastases osseuses d'un cancer prostatique après orchidectomie bilatérale et oestrogénothérapie.

The author reports an exceptional case of 12 years survival in a case of prostatic carcinoma with bone metastases. He notes the high degree of hormone dependence of this tumour which was seen particularly clearly following bilateral orchidectomy. Certain bone metastases disappeared completely whilst others regressed. A precise immunological study demonstrated the preservation of immune potential despite the presence of metastases.

[Retroperitoneal cystic schwannoma. Review of literature. A case report (author's transl)]. / Schwannome kystique rétropéritonéal. Revue de la littérature.

One case of retroperitoneal cystic schwannoma (neurilemoma) in a 35 year old woman is described. With a review of literature are analysed the clinical and anatomo-pathological features of this uncommon tumour and the methods of diagnosis and surgical treatment.

[Cowper's canals and glands. Pathological manifestations and radiologic aspects]. / Les canaux et glandes de Cowper. Manifestations pathologiques et aspects radiologiques.

From 11 personal case studies, the authors conduct a general review of the problems raised by Cowper's glands. Cowper's glands, accessory sexual glands, are made up of main glands situated behind and on either side of the bulbar urethra right at the level of the urolgenital diaphragm and of accessory glands situated in the thickness of the bulbar spongy body. The main glands are drained by long canals (several centimeters in length) which empty into the bulbar urethra by paramedian orifices. The fusion of these canals into one single canal at the urethral opening, although rare, could lead to obstruction. These canals can be the site of cystic dilatation ranging from a few millimeters to as much as 6 cm in diameter. These cysts are rarely due to terminal canal obstruction as the result of chronic inflammatory urethritis. Most often they are congenital. The cysts which develop at the level of the accessory glands are usually obstructive while those which develop at the level of the main glands rather have a perineal expansion. The indicative signs of this particular pathology are not specific (pyuria, hematuria, enureis, known urethral stenosis, dysuria with pollakuria, perineal pain with post voiding urethral dripping). Voiding urethrography investigation (the best) shows: --either cystic dilatation seen as a lacuna on the ventral aspect of the urethra, --or opacification of the dilated cavities of the exretory canals which have been spontaneously broken or opened by endoscopic manoeuvres. The opacification of these cavities leads often to the erroneous interpretation of "diverticula" of "incomplete duplication of the urethra" and yet their essential characteristic is twofold: they are oriented in an anterior-posterior direction with respect to the urethra and lead back and away from it; they have a canal type of morphology for at least part of their course.

[Leydig cell testicular tumour with an endocrine syndrome. Clinical, biological, ultra-structural and histo-enzymatic study (author's transl)]. / Tumeur testiculaire à cellules de Leydig avec syndrôme endocrinien. Erude clinique, biologique, ultra-structurale et histo-enzymatique

With respect to a particularly demonstrative case of Leydig cell tumour with gynaecomastia in a 40 year old man, the authors review the current data in the literature concerning the clinical and biological features and treatment of this tumour. They pay particular attention to the classical anatomo-pathological features, the ultra-structure and the ultrastructural and histo-enzymatic appearances.