[In vitro test of piezoelectric lithotripsy with ultrasound detection using an EDAP LT 01 lithotripser]. / Expérience "in vitro" de lithotripsie pyézo-électrique à repérage ultra-sonique sur le lithotripteur EDAP LT 01.

200 in vitro shots were performed with an EDAP LT 01 system in order to test the sensitivity of the various urinary stones to lithotrity and to study the action of the various shot parameters. All calculi do not have an equally favorable reaction to lithotrity. The deciding factor is neither their hardness, nor their chemical composition, nor their crystallizing shape, but rather the architecture ruling the arrangement of the crystallins forms in the calculus. The most important shot parameter is the power of the system, which conditions its efficiency. However, the shooting method, and more specifically the setting of the shot rate, allows adjusting the shots according to the desired results. The lithotriters will only be improved, ie. made more effective and less traumatic, if these experiments are continued.

[Extracorporeal lithotripsy of biliary lithiasis. 160 patients treated with an EDAP apparatus]. / Lithotriptie extra-corporelle des lithiases vésiculaires. 160 patients traités avec l'appareil EDAP.

Since February 1987, we have been using extracorporeal lithotripsy for certain cases of chronic biliary lithiasis, using an EDAP lithotripter. The technique is reserved for patients with less than four radiotransparent, or partially calcified calculi, less than 25 mm in size, within the context of a functioning gall bladder with no evidence of lithiasis in the C.B.D. Dissolution of the fragments after lithotripsy is ensured by bile salts, this treatment being continued for at least 3 months after the gall bladder has been completely cleared. 160 patients were treated using a total of 181 treatment sessions. Hospitalisation lasted on average 3 days, 1/5th of the patients suffered right hypochondrial pain and nausea for 24 hours. 17% of patients showed a transient elevation in alkaline phosphatase and 12% an elevation in amylase after the procedure. The rate of gall bladder clearance was 24% at 1 month, 40.7% at 3 months ans 50% at 1 year. 11 cholecystectomies were carried out (6.8%), 8 of which were essential. Bile duct migration occurred in 2 cases and produced oedematous pancreatitis in one case. Recurrent lithiasis was noted in 4 cases between 6 and 18 months after gall bladder clearance. 75% of cured patients had a single, radiotransparent stone less than 20 mm in diameter.

[Urinary diversions and intestinal grafts in renal transplantation in children. Report of 8 cases]. / Dérivations urinaires et greffons intestinaux en transplantation rénale chez l'enfant. Rapport de huit cas.

In a series of 400 transplantations, 8 children presented a severe lesion of the lower urinary tract requiring an intestinal graft to divert the urine or to replace the useless bladder: 4 cases of posterior urethral valves and 4 cases of neurogenic bladder. Four permanent urinary diversions and 4 bladder enlargements, including 3 temporary diversions, were performed. The sigmoid colon was used in 5 cases and the ileum was used in 3 cases. The preparation of the intestinal graft was always performed prior to the transplantation. The uretero-intestinal anastomosis included an antireflux device in 3 of the 8 cases. There were no deaths in this series. Three occlusions and 2 lymphoceles occurred in the immediate post-transplantation period, but were corrected by re-operation. Two cases of calculi occurred in the long term, one of which required operation. Moderate stenosis of the renal artery in one case resulted in systemic hypertension which was well controlled by medical treatment. An episode of acute pyelonephritis resolved rapidly with antibiotic treatment. Two cases of acidosis were corrected by salt supplementation. There was one case of early graft rejection on the 15th day and a delayed rejection after 18 months, leading to removal of the transplant. At the present time, 6 renal grafts function normally (75%) with a follow-up of 1 to 8 years.

[Surgical complications of renal transplantation in children. Retrospective study of 372 cases]. / Complications chirurgicales de la transplantation rénale chez l'enfant. Etude rétrospective de 372 cas.

On the basis of a personal series of 372 cases of renal transplantation performed in children, half of whom presented congenital urinary tract malformations, the authors report 110 complications (29.6%). The most frequent complications were urological (14.2%), consisting essentially of fistulae (8.9%) and stenoses (3%). These were followed by vascular complications (6.4%) generally in the form of stenoses (4.8%) and rarely thromboses (1.1%). The authors also report the various local complications which were infectious (wall abscess, suppuration of the renal compartment), haemorrhagic (haematomas) or stones (stones forming on non-resorbable sutures) as well as 5 cases of lymphocele. The prophylaxis of these complications depends on the care taken in collection of the graft (en bloc removal of both kidneys), the restoration of the continuity of the urinary tract (as much as possible Lich-Gregoire extravesical uretero-vesical reimplantation), the vascular anastomoses (vascular dissection limited to a strict minimum), the choice of suture material (resorbable synthetic suture material) and the prevention of infection by systematic pre-, intra- and post-operative antibiotic therapy.

[Antibiotic therapy in ophthalmology]. / L'antibiothérapie en ophtalmologie.

Eye drops containing antibiotics are more and more numerous, we prescribe them more and more frequently. We found it interesting first to gather in six lists all antibiotics used locally in ophthalmology and to study for everyone its bacterial spectrum. After that we see which bacteria are most frequently met by ophthalmologists and when (presurgery examination, conjunctivitis, blepharitis, chalazion, meibomianitis, sty, corneal ulcer, lens infection). All this helps the ophthalmologist to choose the antibiotic he prescribes before the bacteriological specimen, with high confidence. At last, we sum up the little that is presently known about penetration of antibiotics into the eye.

[Obstructive posterior urethral valves. A series of 82 cases]. / Les valves obstructives de l'urèthre postérieur. Une série de 82 cas.

The authors report their experience gained from a series of 82 cases of severe posterior urethral valves with distension of the upper urinary tract. From analysis of their own series and from a study of the literature, they propose a therapeutic approach to these severe forms. Vesico-ureteral reflux was present in 45% of cases. Once the patency of the bladder neck and urethra was restored, 41% of these cases of reflux disappeared spontaneously and 25% persisted but were well tolerated. Only 13 ureters (29.5%) had to be re-implanted. The cases of ureteral distension without reflux had a similar favourable course after removal of the obstruction of the lower urinary tract. 57% of the dilated ureters resolved or were greatly improved and 11% persisted but were well tolerated. Simple treatment of the valves meant that ureterovesical re-implantation was avoided in 68% of cases. The overall results of uretero-vesical re-implantation were mediocre: out of 32 re-implanted ureters, there were only 15 successes (46.9%), 13 cases (40.6%) were unchanged and there were 4 failures (12.5%). The authors recommend the simple treatment of the posterior valves and suggest careful consideration of the indications for ureterovesical re-implantations in children with abnormal bladder and ureters proximal to the posterior urethral valves.

[Pre-operative retina reapplication by active immobilization of the eye with traction sutures]. / Réapplication pré-opératoire de la rétine grâce à l'immobilisation active de l'oeil par fils de traction.

Twenty-five cases of retinal detachment were treated pre-operatively by the so-called active immobilization method described by Rosengren and Algvère. This procedure can be employed for all types of detachment, and gives significant reapplication in 80 p. cent of cases, simplifying subsequent surgery. Complications are rarely observed and can be easily prevented.

[Biliary regeneration. Experimental studies in rats (author's transl)]. / Régénération biliaire. Etude expérimentale chez le rat.

Cholangiographic and histological examinations after partial hepatectomy in rats have demonstrated the presence of biliary as well as hepatocyte regeneration. Commencing very soon after hepatectomy, biliary degeneration is confirmed by radiological investigation, showing hypertrophy of the intra-hepatic biliary canals, and corroborated histologically by evidence of mitoses in the biliary epithelium. This suggests that intravenous cholangiography can be a simple means of evaluating hepatic regeneration after partial hepatectomy in humans.

Perspectives in chronobiology of air pollution.

In a series of experiments, male and female Sprague Dawley rats, kept in light (L) from 06(00) to 18(00) alternating with darkness (LD 12:12) inhaled different concentrations of carbon monoxide (50-1,700 ppm) at each of two test times, 12 h apart. A decrease in flow of CO2 (VCO2) resulting from CO inhalation was greater in the active dark (D) than resting light (L) span. Experimental hypoxic mortality of male and female mice also shows circadian variations, being greater in the D than in the L span. Moreover, a difference of mortality was observed betwen hypoxic exposures performed at 12(00) (in LD or DL) and hypoxic exposures performed at 00(00) (in LD or DL). Such results await tests of any extent to which they model responses of human beings to air pollution. In human beings any external environmental circadian, circaseptan and circannual variations in air pollution as such may serve to variable extent as socioeconomic synchronizers of innate rhythms with a corresponding frequency, rather than as solely generators of time patterns in any physiopathologic response to air pollution.

[Demonstration in Japanese quails of genetic differences in survival from hypoxia]. / Mise en évidence, chez la Caille japonaise, de différences génétiques lors de la survie à l'hypoxie

164 quails (Coturnix coturnix japonica; 94 males and 40 females), 27-55 days old and belonging to 9 families, each family being issued from a different couple of parents, were submitted to an acute nitrogen hypoxia which resulted in an overall mortality of 43.29%. The fact that a high statistically significant (p less than 0,001) heterogeneity was pointed out in these different families supports the existence of a genetic component of resistance towards hypoxia.

[Influence of recent modification of behavioral relationships of male and female OF1 mice on resistance to nitrogen or carbon monoxide hypoxia]. / Influence d'une modification récente de relations comportementales sur la résistance de souris mâles et femelles OF1 à une hypoxie par inhalation d'azote ou d'oxyde de carbone

A decrease of resistance to hypoxia is obtained in OF1 mice, 24 hours after an hyperactivity resulting from a grouping by 13 of male or female mice previously isolated. Besides, this decrease is statistically significant in an acute nitrogen hypoxia but not in an acute carbon monoxide poisoning. In both hypoxias, in mice of same age the males are less resistant than females.

An apparently paradoxical action of aging: decrease of acute hypoxic mortality in male aged rats.

Mortality of SPF male rats due to hypoxic challenge is less in old than in young rats. This apparent antinomy may be related to a decrease in oxygen consumption because of the relation of volume-surface and, in very old rats (590-700 days old), to a selection process wherby only the hypoxiaresistant rats reach old age.