[Egg-shaped macro-lithiasis]. / Macro-lithiase ovoïde.

We report a 76 years-old female patient who consults for left flank pain and inflammatory biology, due to the presence of an egg-shaped 5 cm diameter macro-lithiasis. Because of the presence of a Proteus bacteriuria, the patient receives a 7 days levofloxacin treatment, before a laparoscopic resection of the kidney stone is performed. The analysis reveals a struvite lithiasis with a disorganized radial-section nuclear structure (type IVc).

Nous présentons le cas d'une patiente de 76 ans présentant des douleurs dans le flanc gauche et une biologie inflammatoire, associées à la présence d'une macro-lithiase de forme ovoïde, de 5 cm de diamètre, au sein des cavités rénales gauches. En raison de la présence d'une bactériurie à Proteus, la patiente est traitée par lévofloxacine pendant 7 jours, puis une exérèse de la lithiase a lieu par voie laparoscopique. L'analyse chimique de celle-ci met en évidence une lithiase faite de struvite, avec noyau à section radiale désorganisée (type IVc).

[Total knee replacement with ceramic femoral components: a national prospective multicenter study of clinical and radiological outcomes]. / Knieendoprothetik mit keramischen Femurkomponenten: Nationale prospektive Multicenterstudie zum klinischen und radiologischen Outcome.

BACKGROUND: The purpose of this prospective multicenter study was to evaluate the clinical and radiological outcomes of an unconstrained bicondylar total knee prosthesis with a new ceramic femoral component made of BIOLOX® delta. MATERIAL AND METHODS: Fifty patients underwent cemented total knee arthroplasty in three hospitals/centers. Clinical and radiological evaluations were undertaken preoperatively and at 3 as well as 12 months postoperatively using the HSS, WOMAC, and SF-36 scores. RESULTS: During 12 months follow-up three patients had to undergo revision surgery due to non-implant-related reasons (infection, periprosthetic fracture, and retropatellar replacement). The mean preoperative HSS score amounted to 56.2±11.0 points. At 3 and 12 months follow-up the mean HSS score was 75.5±11.5 and 83.6±10.9 points, respectively. Therefore, HSS and WOMAC scores improved significantly from preoperative values at both postoperative evaluations. The first significant improvement of SF-36 score was seen after 12 months. Radiolucent lines around the femoral ceramic components were found in one case. CONCLUSION: Subsequent long-term studies must be carried out in order to clarify the potential benefits of ceramic femoral components and confirm the good early clinical result. Moreover, the specific material properties of ceramic implants must be considered during implantation.

[Decrease ApoB/ApoA-1 ratio and cardiovascular risk improvement: a tadalafil pleiotropic effect? Preliminary study on healthy volunteers]. / Diminution du rapport ApoB/ApoA-1 et amélioration du risque cardiovasculaire : effet pleïotropique du tadalafil ? Etude préliminaire sur volontaires sains.

OBJECTIVES: Recognition of erectile dysfunction (ED) as an early sign of systemic cardiovascular disease offers an opportunity for prevention. Cardiac risk assessment may deserve measurement of Apolipoprotein B/Apolipoprotein A-1 ratio. An elevated ApoB/ApoA-1 ratio is a risk factor for future coronary artery disease. ApoA-1 production, which is recognized as a cardioprotective lipid fraction, is down regulated by NFkappaB activation in vitro. Because inhibition of phosphodiesterases (PDEs) 5, 6 and 9 negatively attenuates NFkappaB translocation/activation, tadalafil, a selective PDE 5 inhibitor used for treatment of ED could present some interesting pleiotropic effects. The objective of this open study is to test the hypothesis that tadalafil treatment could decrease serum ApoB/ApoA-1 ratio. MATERIAL AND METHODS: Ten healthy men without any complain of ED or known cardiovascular risk factors were administered tadalafil 10mg intake on alternate days for 4 weeks. Lipid profile with total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, ApoA-1 and ApoB, was assessed at baseline (T0), after 2weeks (T1), at the end of the treatment period (T2) and after 2weeks of wash-out follow-up (T3). RESULTS: ApoB/ApoA-1 ratio was significantly decreased during treatment (mean+/-SEM, T0: 0.80+/-0.11, T1: 0.64+/-0.06, T2: 0.65+/-0.06; p<0.05) and remained lower after wash-out (T3: 0.67+/-0.05; p=0.08). Serum ApoA-1 (mg/dl) increased but not significantly during the treatment period (15.2+/-8.8, 16.5+/-7.9, 16.9+/-6, 15.3+/-7, p=0.26) and ApoB (mg/dl) significantly decreased (11.7+/-10.8, 10.3+/-8.4, 10.6+/-9.9, 10.2+/-8.6, p=0.03). HDL and LDL cholesterol were unchanged. CONCLUSION: This preliminary study showed the interest of PDE 5 inhibitors to decrease the cardiac risk factor ApoB/ApoA-1 ratio. Randomised controlled studies with longer follow-up are needed to confirm those results.

Small cell anaplastic carcinoma of the prostate: a clinical, pathological and immunohistological study of 27 patients.

Because small cell anaplastic carcinoma of the prostate is an uncommon tumor, it has remained a poorly defined entity. To elucidate further the clinical, pathological and immunohistochemical characteristics of this cancer the 27 patients who presented to the Mayo Clinic from 1960 to 1990 were reviewed. Of these patients 18 (67%) presented with pure small cell anaplastic carcinoma, and 9 (33%) were diagnosed with small cell anaplastic carcinoma and adenocarcinoma of the prostate. Twenty-six patients (96%) had either stage C or D disease at the time of diagnosis. Two patients presented with a paraneoplastic syndrome, including 1 man with inappropriate antidiuretic hormone secretion and 1 who suffered from thyroxine intoxication. Of 24 men with long-term followup 22 (92%) died of small cell anaplastic carcinoma of the prostate despite antiandrogen therapy and the remaining 2 are alive with active, progressive disease. The median survival time following diagnosis was 17.1 months (range 2 to 90 months). All tumors with tissue available for immunohistochemical staining reacted positive for neuron-specific enolase, indicating that small cell anaplastic carcinoma of the prostate is most likely a neuroendocrine neoplasm. No tumor stained positive for either prostatic acid phosphatase or prostate specific antigen. Pathologically, small cell anaplastic carcinoma of the prostate appears to be similar to oat cell carcinoma of the lung. This series of 27 patients emphasizes that small cell anaplastic carcinoma of the prostate is highly malignant, is frequently of advanced stage at presentation, responds poorly to antiandrogen therapy and has a poor prognosis.

[S. Raz' method of bladder suspension and treatment of cystocele in urinary stress incontinence (short-term results)]. / Vésico-suspension et cure de cystocèle dans l'incontinence urinaire d'effort selon S.Raz (résultats à court terme).

We performed the transvaginal approach described by S. Raz for stress urinary incontinence and cystocele. 13 patients with cystocele and stress urinary incontinence underwent the four corner Bladder neck suspension 12 patients with stress urinary incontinence alone underwent simple bladder neck suspension. After a median follow-up of 4,1 months 92% were cured of incontinence. Cystoceles grade II and III were completely reduced. These results are comparable with abdominal approach for less morbidity and shorter hospital stay.

Transrectal ultrasound in the diagnosis and staging of prostatic carcinoma.

In this retrospective study we try to evaluate the benefit of transrectal ultrasonography of the prostate in the diagnostic, the screening and the preoperative staging of prostatic carcinoma. Five hundred and sixty-six patients with histologically proved prostatic carcinoma were evaluated. For the diagnosis, our specificity was 80%. The specificity of preoperative staging was 85% concerning the extraprostatic extension of the tumor. The screening seems to be of poor interest.