Comparative analysis of MiB1 and p53 expression in human bladder tumors and their correlation with cancer progression.

Expression of p53 and MiB1, markers of tumor proliferation, was evaluated in human bladder tumors, and correlated with ploidy and cancer progression in 83 consecutive patients. Transurethral resection of a newly diagnosed bladder tumor was performed in 73 cases, and systematic bladder biopsies were performed in 10 cases after bacillus Calmette-Guerin (BCG) treatment. p53 and MiB1 expression were performed by an immunohistochemical technique and the ploidy was determined on a frozen fragment of the tumor. p53 expression was correlated in relation to grade, stage and combination of grade and stage. MiB1 expression was correlated with cytological grade, and a significant difference was demonstrated between pT0 and pTa, pTa, and pT1, pTa and pT2 tumors but not between pT1 and > or = pT2 tumors. A discordance was observed for the comparison of p53 and MiB1 values, stage by stage, suggesting that these two techniques are independent of each other. A larger proportion of aneuploid tumors were positive for p53 and MiB1 (64.8 vs. 86.5%, respectively), but p53 and MiB1 immunostaining were not better indicators than ploidy alone to predict cancer progression.

[Biopsy of the seminal vesicles in the staging of localized cancer of the prostate: technic and results]. / La biopsie des vésicules séminales dans la stadification du cancer de la prostate localisé: technique et résultats.

OBJECTIVE: To allow the diagnosis of pathological stage C prostatic cancer before deciding on treatment. METHOD: Seminal vesicle biopsy was performed as an outpatient procedure without anaesthesia. An identical antibiotic prophylaxis to that used for prostatic biopsy was performed. Biopsies were performed by longitudinal vision using a transrectal probe. A seminal vesicle needle biopsy was performed lateral to the prostate in the medial third of the seminal vesicle. RESULT: When seminal vesicle biopsies are positive, the final pathology report after radical prostatectomy confirmed the diagnosis in 100% of cases. When seminal vesicle biopsies were negative, seminal vesicle invasion was detected on the final pathology examination in one third of cases, mostly corresponding to exclusively intraprostatic involvement of the seminal vesicle. Biopsies are useful when at least one of the two prostatic bases is involved. In the series of the last 42 radical prostatectomies performed because of negative seminal vesicle biopsies, we detected only 11% of capsular lesions, almost always less than 1 mm, and 0% of ilio-obturator lymph node invasion. CONCLUSION: Although the digital rectal examination findings, the PSA level, the Gleason score, and the number of positive biopsies and their length, allow an approach to preoperative staging, only seminal vesicle biopsies can provide a better preoperative staging of prostatic cancer for a given patient and no longer just statistically.

[Vestigial cysts of the anterior intestine of unusual localization. Report of two cases]. / Kystes vestigiaux de l'intestin antérieur de localisation inhabituelle. A propos de deux observations.

Bronchogenic cysts and enteric cysts both result from an aberration of development of the anterior gut. Their usual location is the mediastinum. The abdominal or retroperitoneal location of such cysts is rare and raises problems in terminology and pathogenesis. We report two cases of an unusual location of bronchogenic and enteric cysts. We also recall the criteria of diagnosis and the pathogenesis.

[Retroperitoneal adrenal subdiaphragmatic bronchogenic cyst: apropos of a case and review of the literature]. / Le kyste bronchogénique sous-diaphragmatique sus-rénal rétro-péritonéal: à propos d'un cas et revue de la littérature.

The authors report a case of retroperitoneal subdiaphragmatic bronchogenic cyst. The embryological and histological features of the cyst are discussed, together with the diagnostic and therapeutic modalities.

[Reliability of pressure measures determined with probes used for establishing the urethral pressure profile by the perfusion method]. / Fiabilité des measures de pressions obtenues par les sondes utilisées pour la réalisation du profil de pression uréthral par la méthode perfusionnelle.

The objective of this study was to evaluate the reliability of pressure measurements by the main catheters used to determine urethral profiles by the perfusion method. This evaluation, performed on a test bench, compared the reference pressure in a tank filled with water to that measured by the catheter tested. The reliability of the measurement varied from one catheter to another. This disparity was due to differences of load losses, leading to an overestimation of the measurement (by 2 to 17 centimetres of water), which must be corrected by adjustment of the zero pressure with a perfused catheter. Major differences in the rapidity of response (from zero to five seconds) were also observed, which appear to be related to elastic properties of the catheter. This study does not pretend to globally verify the reliability of the perfusion method, but only the reliability of pressure measurements.

[Urethroplasty in 2 stages using skin grafts]. / Uréthroplastie en 2 temps par greffe cutanée.

OBJECTIVE: To present the technique and results of 2-stage mesh-graft urethroplasty, as described by Schreiter in 1984. METHODS: 11 patients with a stricture of the anterior urethra were treated according to this urethroplasty (pedicle skin flap). The site of the stricture was penile in 4 cases and perineoscrotal in 7 cases, and the mean length was 7.7 cm (range: 3 to 12.5). RESULTS: 10 patients were treated in 2 stages, while the remaining patient has a persistent perineal urethrostomy. With a mean follow-up of 3.5 years (range: 14 to 77 months), 9 patients obtained a satisfactory result with no radiographic recurrence, but with persistent nocturia (x 2/night), a mean peak flow rate of 12.8 ml/s, and a mean residual urine of 55 ml present in 8 our of 9 cases. One complete failure was observed, following complete recurrence of the stricture due to the limited dimensions of the skin flap at the 2nd stage. CONCLUSION: This technique constitutes a useful salvage solution after failure of a one-stage urethroplasty. It can be used to treat extensive strictures of the anterior urethra by reconstituting a good quality urethral lumen with well vascularized tissue. It also has the advantage of avoiding the presence of hair follicles and allows the two stages to be performed at a brief interval.

Influence of preoperative positive seminal vesicle biopsy on the staging of prostatic cancer.

A total of 71 patients with clinically localized prostatic cancer underwent preoperative biopsy of each seminal vesicle. Group 1 (67 patients) underwent 2 seminal vesicle biopsies before lymph node dissection and vesiculo-prostatectomy, while group 2 (4 patients) underwent seminal vesicle biopsy and lymph node dissection before radiation therapy. In group 1 there were 11 positive biopsies (16.5%) with a median prostate specific antigen (PSA) level of 24 ng./ml. (range 11 to 45). Of the biopsies 56 were normal, with a median PSA level of 11.8 (range 3.5 to 88, p < 0.008). Histological examination of the seminal vesicles on the prostatectomy specimen revealed 18 cases of seminal vesicle invasion (sensitivity 61%, specificity 100%, positive predictive value 100% and negative predictive value 87.5%). A positive biopsy was correlated with the mean tumor volume (10.3 cc with positive biopsies versus 4.9 cc with negative biopsies) and local invasion (positive margins in 36% versus 9%, respectively, and capsular perforation in 81% versus 25%, respectively). In group 2 the 4 seminal vesicle biopsies and lymph node dissections were positive. Overall (groups 1 and 2), positive seminal vesicle biopsies were predictive of lymph node involvement in 47% of the cases versus 7% when biopsies were negative (p > 0.001). The postoperative course was significantly different (local recurrence and metastases in 45% versus 9%, respectively, and median interval 8.8 months versus 18.3 months, respectively, p < 0.001). Seminal vesicle biopsy appears to have a satisfactory yield only in cases with a PSA level of greater than 10 ng./ml. A positive seminal vesicle biopsy confirms the presence of extraprostatic invasion of clinically localized cancer in a given patient. Seminal vesicle biopsy allows for better staging of prostatic cancer.

[The morbidity of radical prostatectomy using a retropubic approach: a series of 150 cases]. / La morbidité de la prostatectomie radicale par voie rétropubienne: une expérience de 150 cas.

The authors studied the morbidity of retropubic radical prostatectomy in 150 patients operated between December 1983 and March 1993. The perioperative mortality was zero. A rectal injury occurred in 3 cases (2%) and was repaired immediately without colostomy. The median operative blood loss was 1,500 ml. 36.6% of cases developed perioperative complications. 8% of early postoperative complications (< 1 month) required reoperation. Major complications (thromboembolic and septic) were observed in 3.2% of cases. The late postoperative complications included fibrous stenosis of the urethrovesical anastomosis in 12% of cases with a median time to onset of 4 months: 3.6% of patients developed an anastomotic stenosis due to local recurrence. 12.6% of cases developed persistent urinary incontinence (6.6% of minor incontinence, 5.3% of moderate incontinence and 0.7% of severe incontinence). Incontinence was more frequent (p < 0.05) among the first 75 patients of the series. Erectile function was preserved in 19.8% of patients. The incidence of post-operative impotence was significantly lower (p < 0.01) in patients under the age of 60 years (65% vs 94.8%). Radical prostatectomy, considered to be the most appropriate treatment for localised prostatic cancer, can now be performed with acceptable morbidity.

[Incidence of the form and caliber of urethral resistance. Evaluation for a normal masculine urethra and in cases of obstruction due to prostatic hypertrophy]. / Incidence de la forme et du calibre dans la résistance uréthrale. Evaluation pour un urèthre masculin normal et en cas d'obstruction par hypertrophie de prostate.

Certain forms of benign prostatic hypertrophy are associated with a reduction of the calibre of the prostatic urethra of the median lobe, a defect of infundibulisation of the bladder neck and a dilated appearance of the bulbar urethra. The objective of this study was to verify whether hydrodynamic arguments could be used to confirm the concept that defective infundibulisation of the bladder neck is directly responsible for an obstructive syndrome or via a reduction in the calibre of the bladder neck orifice. More generally, this study was designed to quantify the distribution of resistance to flow along the normal urethra and to define the role of cervicoprostatic and urethral deformities in the obstruction associated with benign prostatic hypertrophy. Urodynamic studies are unable to answer this question, as the instantaneous urethral resistance is evaluated globally by the Pressure-Flow relation. The authors performed morphological analysis to divide the urethra into simple hydraulic segments for which the corresponding pressure drop coefficients were calculated. These coefficients constitute an approach to segmental resistance to flow and can be used to quantify changes in shape observed on voiding urethrography or ultrasonography. Digital analysis of voiding urethrographies showed that, under normal conditions, urethral resistance was regularly distributed along the urethra and essentially depended on friction of the urethral wall. In the case of benign prostatic hypertrophy, even with a median lobe, the increase in the pressure drop coefficients was due to a reduction in the calibre of the bladder neck orifice and prostatic urethra. Cervical deformities appeared to be minimally obstructive, according to urodynamic parameters, if they were not associated with a reduction in the calibre of the bladder neck orifice.

[Cancer of the penis: the value of systematic biopsy of the superficial inguinal lymph nodes in clinical N0 stage patients]. / Cancer du pénis: valeur de la biopsie systématique des ganglions inguinaux superficiels chez les patients N0 clinique.

From 1985 to 1991, bilateral surgical biopsy of the superomedial group of superficial inguinal lymph nodes, considered to be the first draining nodes, was performed in 24 patients with clinical stage T1-3 N0 M0 squamous cell carcinoma of the penis at the same time as surgical treatment of the primary. This procedure was technically successful in every case, but no lymph node metastases were detected. As bilateral biopsy was negative in these 24 patients, clinical surveillance was implemented: review every 2 months for 2 years and self-palpation by the patient. Seven patients (29.1%) developed one or more suspicious ilio-inguinal lymph nodes after a mean interval of 11.85 +/- 8.02 months: 1) In 6 patients, bilateral ilio-inguinal lymph node dissection was then performed, confirming the neoplastic nature of the inguinal node metastases without iliac metastases in 3 of these patients. 2) As the remaining patient presented with unilateral iliac node metastases, proven histologically by surgical biopsy, systemic chemotherapy was introduced prior to ipsilateral inguinal lymph node dissection. This finding questions the theory according to which the sentinel superomedial inguinal node constitutes the first draining node and demonstrates the existence of several pathways of lymphatic drainage towards superficial and deep inguinal nodes. This biopsy, which was always negative in our series, is insufficient to guide our therapeutic approach in clinical N0 patients. The decreased complication rate following inguinal lymph node dissection should certainly encourage us to prefer surgery, particularly superficial inguinal lymph node dissection with preservation of the great saphenous vein.

[Urethral mucosal prolapse in girls. Apropos of 24 cases]. / Le prolapsus muqueux urétral chez la fille. A propos de 24 cas.

We performed surgery in twenty-four cases of urethral prolapse between 1973 and 1989 at the hospital of Fort-de-France. Urethral prolapse is a benign lesion of the terminal urethra and is predominant in young, 3 to 6 year-old black females. Vulvar hemorrhagic is the most usual initial symptom, and diagnosis is readily made by examination and urethral catheterization. Excision of the prolapsed mucosa followed by immediate muco-mucous suture permits a generally uneventful recovery without prolonged hospitalization.

[Sterility and tumors of the testis. Study of late exocrine and endocrine functions in stage I or IIA tumors]. / Stérilité et tumeurs du testicule. Etude des fonctions exocrine et endocrine à distance dans les tumeurs de stade I et IIA.

Spermatogenesis and plasma hormone levels (testosterone, follicle stimulating hormone and 17 beta estradiol) were studied in patients presenting stage I or IIA testicular tumors. Patients with a previous history of cryptorchidism or varicocele, and those who had received combined chemotherapy, were excluded. In 22 patients (10 seminomas and 12 non-seminoma tumors) a spermogram was obtained at the time of orchidectomy, before the procedure in 9 cases and immediately afterwards in 13. Hormone levels, together with tumor marker assay (alpha feto protein and beta HCG) were determined preoperatively. Exocrine and endocrine function were restudied after 3 years of follow up. There was an initial restudied after 3 years of follow up. There was an initial deterioration in spermatogenesis in 17 patients (77.8%) as shown by a sperm count less than 20 million per cm3, an ejaculate volume less than 1.5 cm3 and a motility after one hour of less than 60%. In this group 11 patients had a sperm count of less than 10 million per cm3. Endocrine anomalies discovered included an increase in serum beta HCG levels (7 cases), combined with a decrease in follicle stimulating hormone and an increase in 17 beta estradiol. After 3 years, only 5 of these 17 patients demonstrated fertile sperm (29.4%). The endocrine anomalies tended to regress after orchidectomy. While these endocrine anomalies were always accompanied by hypofertility, their absence was not synonymous with a normal spermogram. Thus the reestablishment of fertile sperm remains unlikely even in early stage testicular tumors.

[Cystic adenoid cancer of the esophagus. Report of a case and review of the literature]. / Cancer adénoïde kystique de l'oesophage. Rapport d'une observation et revue de la littérature.

A 59-year-old man had adenoid cystic carcinoma of the esophagus. The tumor, in the lower third of the esophagus, was resected; the patient died 7 months after surgery from widespread distant metastases. The initial diagnostic was epidermoid carcinoma on the biopsy. In the literature adenoid cystic carcinoma are frequently associated with epithelial abnormalities. Also of interest within the literature was the fact that radiotherapy and combination chemotherapy may be an effective treatment modality for this cancer.

[Acute pancreatitis caused by isolated involvement of the pancreas after closed abdominal injury]. / Pancréatite aiguë par atteinte isolée du pancréas après traumatisme abdominal fermé.

Acute post-traumatic pancreatitis in unusual, accounting for no more than 1% of all cases of acute pancreatitis. The authors describe a case of acute pancreatitis in a patient who had a closed abdominal trauma during a football match. The recommended procedures for ensuring early diagnoses are described. Prognosis and management is dependent upon pathology and extension of lesions. Hemorrhagic and necrotic pancreatitis carries a poor prognosis, especially when diagnosis is delayed.

[Rhabdomyolysis with acute renal failure and malignant neuroleptic syndrome]. / Rhabdomyolyses avec insuffisance rénale aiguë et syndrome malin des neuroleptiques.

Seven episodes of rhabdomyolysis with acute renal failure (ARF) have been observed in 6 patients treated with various short-acting tranquilizers and antidepressants. Clinical features usually included severe hyperthermia, diffuse hypertonicity with or without coma, circulatory failure or unstable blood pressure, and often acute respiratory failure. Serum CPK were always elevated. The type of ARF was prerenal failure without oliguria in 5/7 episodes, and acute tubular necrosis in 2/7 episodes, requiring hemodialyses in one patient. Three patients died. In any case, the tranquilizers and antidepressants responsible for this syndrome were stopped, and electrolyte disorders and acidosis were corrected. Associated acute circulatory failure, septicemia and/or acute hepatic failure required prompt therapy, and artificial ventilation was required in 4 instances. The further use of phenothiazines, butyrophenones, sulpiride and their derivatives should be avoided in any patient having developed such an accident, whose pathophysiology is similar to that described in malignant hyperthermia of various origin.

[Acute respiratory distress syndrome of tuberculous origin in an intensive care unit. Clinical presentation and course (author's transl)]. / Syndrome de détresse respiratoire aiguë d'origine tuberculeuse en réanimation. Aspects symptomatiques et évolutifs.

The authors have observed 6 cases of acute respiratory distress syndrome (ARDS) of tuberculous origin. The condition presented as pulmonary oedema in 4 cases and as extensive bilateral pneumonia in 2. Pulmonary oedema was treated by artificial ventilation with intermittent positive pressure in 2 patients who died, and by continuous positive airway pressure in 2 patients who survived. The 2 patients with pneumonia survived without respiratory assistance. In these patients with atypical symptoms, early diagnosis (which may involve liver and bone marrow biopsies) and immediate therapeutic measures are life-saving. The diagnosis of tuberculosis should be systematically considered in adult ARDS, especially i patients with pulmonary oedema of unknown origin.