[Management of lithiasis of kidney transplant]. / Prise en charge de la lithiase sur rein transplanté.

INTRODUCTION: Urolithiasis in kidney transplants is rare but not exceptional (0,20-3%). Dealing with it is complex: abstention, lithotripsy or surgery? The aim of this study is to find out what can be done about it. METHOD: A retrospective study about 420 kidney transplants performed in our institution between 1990 et 2005 revealed nine cases of lithiasis. Among the factors leading to lithiasis were urinary flow obstruction in six cases and hyperparathyroidy in three cases. RESULTS: Five grafts with calculi whose diameter do not exceed 5mm were kept under medical supervision. Two of them were in chronic rejection without residual diuresis. Extra shockwawe lithotripsy was performed for a 13 mm diameter calical calculi. Two percutaneous extraction were performed: one for a 20mm diameter "pyelic" calculi and one for three kidney stones and among them one was 12 mm. A 20mm calculi was extracted by open pyelotomy during the repairing of the ureteral anastomosis on a Bricker diversion. CONCLUSION: Consequently, dealing with calculi on kidney transplants is similar to dealing with a unique native kidney.

Rheumatoid arthritis-induced pseudotumoral AA amyloidosis of the bladder with vesico-peritoneal fistula.

Rheumatoid arthritis-induced AA amyloidosis of the bladder is rare, with fewer than 25 cases reported so far. This localization may be life-threatening with a mortality rate of about 60%, most often due to massive hematuria or multiorgan failure as a result of systemic amyloidosis. We report the case of a 72-year-old woman with a long history of rheumatoid arthritis who developed gross hematuria that induced severe anemia. Ultrasonography and tomodensitometry revealed a large mass localized in the upper part of the bladder. Cystoscopy showed a congestive inflammatory area with a large vesicoperitoneal fistula. Biopsies revealed amyloidosis, and immunohistochemical staining of the specimens defined the process as AA amyloidosis. The amyloid deposits were also found in the rectum, duodenum, uterus and kidneys. This case of rheumatoid arthritis-induced AA amyloidosis of the bladder is characterized by its pseudotumoral aspect and the existence ofa vesico-peritoneal fistula: only 2 cases have been reported so far. Treatment was symptomatic, and the patient died from cachexia. The pseudotumoral forms of AA amyloidosis, including amyloidosis of the bladder, deserve an early correct diagnosis. Otherwise, an incorrect diagnosis, especially cancer, may prompt inappropriate treatments.

[Treatment of ureteropelvic junction stenosis with cold blade retrograde endopyelotomy]. / Traitement des sténoses de la jonction pyélo-urétérale par endopyélotomie rétrograde à la lame froide.

BACKGROUND: The classical treatment of ureteropelvic junction (UPJ) stenosis consists of open surgical resection-anastomosis. Endopyelotomy, a less invasive procedure, allows antegrade or retrograde endoscopic incision of this junction. The authors' experience of cold blade retrograde endopyelotomy (CBRE) is presented and compared with other techniques. MATERIAL AND METHOD: Thirteen patients (3 men and 10 women), with a mean age 55.3 years, underwent CBRE with ureteroscopic and fluoroscopic control for primary (10/13) or secondary (3/13) UPJ stenosis. The clinical and urographic efficacy of the method was assessed retrospectively. RESULTS: Median operating times and hospital stays were 40 min and 4 days respectively. The postoperative complication rate was 15.4% (two urinary tract infections). Eleven of the 13 patients are currently symptom-free with a mean follow-up of 26.5 months. Follow-up urography (mean follow-up: 11.9 months) shows a satisfactorily revascularized junction in 84.6% of cases (1 asymptomatic stenosis, 1 symptomatic stenosis revised by open surgery). CONCLUSION: Compared to the other treatments of UPJ stenoses, CBRE is a simple, minimally invasive technique, which reduces operating time and hospital stay and therefore presents a good cost-efficacy ratio.

[Coloplasty after esophagectomy in cancer. A retrospective study of morbidity and mortality]. / Les coloplasties après oesophagectomie pour cancer. Etude rétrospective de la morbidité et de la mortalité.

Aim of this study has been to evaluate retrospectively morbidity and mortality of 42 colon substitutions after resection for esophageal cancer. Colon substitution was the intervention of first choice in six patients. In the other patients the stomach was useless, because of previous gastric surgery (n = 14), of gastric involvement by the tumor (n = 21) or technical problem (n = 1). Patients have been separated in 2 groups: from 1969 to 1983 (group A, n = 22), and from 1983 to 1997 (group B, n = 20). Mortality and morbidity (all eventful postoperative course) have been collected for the 30 postoperative days. Total morbidity has been 57% as 77% in group A and 35% in group B (p < 0.05). Cervical and colo-colic leak have been the most common complications. Total mortality has been 14% as 22% in group A and 5% in group B (p < 0.1). In group A 3 patients died from anastomosis leak (intrathoracic or intraabdominal) and 2 from medical complications. In group B 1 patient died from unexplained sepsis. Our results show significative decrease of morbidity and mortality in group B. These results can be compared to those of gastroplasty for cancer or coloplasty for benign disease. In cancer of the esophagus, if stomach can not be used as substitutes, colon substitution is the best alternative, which can be used without increase of mortality and morbidity.

[Regression of retroperitoneal fibrosis treated by tamoxifen]. / Régression d'une fibrose rétro-péritonéale traitée par le tamoxifène.

By analogy with desmoid tumours, tamoxifen has been used in the treatment of idiopathic retroperitoneal fibrosis. The authors report the 6th case of retroperitoneal fibrosis treated by tamoxifen alone, which had not recurred 11 months after stopping treatment.