[Value of nuclear medicine in preventive cardiology: the metabolic syndrome example]. / Apports de la médecine nucléaire en cardiologie préventive: l'exemple du syndrome métabolique.

Metabolic syndrome represents a grouping of risk factors closely linked to cardiovascular diseases and diabetes. At first, nuclear medicine has no direct application in cardiology at the level of primary prevention, but positron emission tomography is a non invasive imaging technique that can assess myocardial perfusion as well as the endothelium-dependent coronary vasomotion--a surrogate marker of cardiovascular event rate--thus finding an application in studying coronary physiopathology. As the prevalence of the metabolic syndrome is still unknown in Switzerland, we will estimate it from data available in the frame of a health promotion program. Based on the deleterious effect on the endothelium already observed with two components, we will estimate the number of persons at risk in Switzerland.

[Kidney cancer and pancreatic metastases. Report of 3 cases]. / Cancer du rein et métastases pancréatiques. A propos de 3 cas.

Simultaneous or secondary pancreatic metastases of primary renal cancer are exceptional and usually delayed. The clinical signs of symptomatic lesions are varied and nonspecific. Computed tomography allows complete investigation and CT angiography visualizes typical hypervascularization, which can be correlated to angiographic examinations. In the light of 3 cases treated surgically with a significant clinical follow-up, the authors review the data of the literature.

[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.

[Corynebacteria D2 and encrusted cystitis with alkaline urine]. / Corynébactéries D2 et cystite incrustée à urines alcalines.

In the light of an informative clinical case report, the authors emphasise the pathogenic role of Corynebacteria D2 in urinary tract disease. This microorganism can be easily detected by bacteriologists by the use of special media and such infection is suggested clinically by urinary tract infection with "sterile", strongly alkaline urine. The clinical features of incrusted cystitis with alkaline urine may be accompanied by serious upper urinary tract complications with renal failure, recurrent haematuria with anaemia, decreased bladder capacity and incontinence. Corynebacteria D2, an opportunistic pathogenic bacteria, responsible for nosocomial infection, is resistant to the majority of antibiotics. The authors complete their case report with a review of the literature.

[Sarcoma of the spermatic cord. Report of 2 cases. Review of the literature]. / Sarcomes du cordon spermatique. Rapport de 2 cas. Revue de la littérature.

Illustrated by a case of rapidly fatal rhabdomyosarcoma in a child and a leiomyosarcoma in an adult, the authors differentiate the various histological types of sarcomas affecting the spermatic cord. Based on a review of the literature, they stress the great variety and various clinical courses related to the histological type. The predominant role of the histologist is stressed. The most widely used classifications are reviewed, leading to treatments in which primary surgery should be as complete as possible and combined with lymph node dissection or radiotherapy and chemotherapy. At the present time, the use of chemotherapy appears to be the decisive step in the improvement of the survival rates. The lymphophilic nature of rhabdomyosarcomas, which are embryonal in 95% of cases in children, can be schematically contrasted with the haematogenous nature of other sarcomas. The current approach to sarcomas of the spermatic cord, a minor site in comparison with the frequency of other soft tissue sarcomas, consists of an aggressive multidisciplinary treatment.

[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.

[Efficacy of Pygeum africanum extract in the medical therapy of urination disorders due to benign prostatic hyperplasia: evaluation of objective and subjective parameters. A placebo-controlled double-blind multicenter study]. / Wirksamkeit eines Extraktes aus Pygeum africanum in der medikamentösen Therapie von Miktionsstörungen infolge einer benignen Prostatahyperplasie: Bewertung objektiver und subjektiver Parameter. Eine placebokontrollierte doppelblinde Multizenterstudie.

The efficacy of an extract of Pygeum africanum in the treatment of micturitional disorders due to benign prostatic hyperplasia was tested in a multicentre double-blind trial versus placebo. Capsules containing 50 mg of Pygeum africanum extract or placebo were administered at a dosage of 1 capsule in the morning and 1 capsule in the evening over a period of 60 days. 263 patients were included in this study, which was carried out in 8 centres in Germany, France, and Austria. Evaluation was mainly based on quantitative parameters such as residual urine, uroflowmetry and the precise monitoring of diurnal and nocturnal pollakiuria. Treatment with the Pygeum africanum extract led to a marked clinical improvement: a comparison of the quantitative parameters showed a significant difference between the Pygeum africanum group and the placebo group with respect to therapeutic response. The characteristic subjective symptoms of micturitional disorders, which were evaluated by the patients in a qualitative manner, were also significantly improved by administration of Pygeum africanum extract. Overall assessment at the end of therapy, showed that micturition improved in 66% of the patients treated with Pygeum africanum extract, as compared with an improvement of 31% in the placebo group. The difference was significant at the statistical level of p less than 0.001. During therapy with Pygeum africanum extract, gastrointestinal side effects occurred in 5 patients. Treatment was discontinued in three of those cases.

[Bladder biopsy in the diagnosis of urogenital tuberculosis]. / Apport de la biopsie vésicale dans le diagnostic de la tuberculose uro-génitale.

The authors report 5 cases of urogenital tuberculosis where examination of the urine failed to reveal any B.K. The diagnosis was suggested by the history of tuberculosis and the radiological appearance by intravenous pyelography. However, it was not possible to start an antituberculosis therapy in the absence of bacteriological proof. Forceps biopsy for histological examination provides an additional argument: the highly typical tuberculosis granuloma.

[Heavy haematuria as the presentation of attenuated haemophilia B (author's transl)]. / A propos d'une hématurie grave révélatrice d'une hémophilie B atténuée.

The authors report a rare case of eosinophilic cystitis presenting with heavy haematuria which led to the discovery of attenuated haemophilia B. Bleeding and clotting times in this patient, with no past history of haemorrhage, were normal. Complete coagulation studies led to the diagnosis in the presence of poor plasma prothrombin consumption and a moderate deficit in clotting factor IX, defining haemophilia B. Despite two partial cystectomies for haemorrhagic lesions of the dome of the bladder (eosinophilic cystitis), carried out with transfusion cover and the administration of P.P.S.B., recurrence of haematuria made it necessary to "rest" the bladder by a cutaneous ureterostomy. Subsequently, the restoration of urinary continuity was possible by uretero-ileo-cystoplasty, without any haemorrhagic complications by virtue of the use of P.P.S.B. The value of the association of epsilon amino-caproic acid with P.P.S.B. is emphasised in the prevention of haemorrhagic complications during surgery in haemokphilia B patients. In attenuated forms of haemophilia B (factor IX level between 5 and 15%) haemorrhages may be only occasional and occur only late in life.

[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.

[Urothelial inverse papilloma. Review of the literature (appropos of 2 cases: 1 vesical, the other urethral)]. / Papillome inversé urothélial. Revue de la littérature (a propos de 2 cas : l'un vésical, l'autre uréthral).

The authors report two cases of urothelial inverse papilloma and review the 94 observations in the published literature. Some fundamental features of the condition are outlined: 1) DEFINITION: paramalpighian papillary tumor which spreads towards the chorium but does not invade it, and lies under the intact urothelium which is folded towards the lumen of the urinary tract, 2) Site: usually cervicotrigonal but may be urethral; 3) Evolution: usually benign but sometimes recurrent; 4) Histogenesis: abnormal proliferation of Von Brunn's islets. 5) Association: possible with bladder carcinomas.

[Problems of cystic uretero-pyelitis (author's transl)]. / Problèmes posés par la pyélo-uré,érite kystique.

The authors report on a series of 7 new cases of cystic uretero-pyelitis (C.U.P.). An historical and pathogenic review of this anatamo-radiologic entity is presented. The conditions for discovery were: renal colic in 4 instances, discovery during surgery in association with a pyeo-ureteral junction syndrome in one instance, and a hematuria in three instances (1 being accompanied by renal colic). Age varied from 22 to 78 years, with an average age of 61 years. The distribution between the sexes was equal: 4 women and 3 men. Urinary infection was observed in cases (colibacilluria), whereas it was absent in 3 cases. If hematuria is present, one should, as a rule, look for a possible association with an ureteral or vesical tumor (1 case). The final diagnosis can be established only through histological examination (this was the case in only 3 of our patients), but when there is a suggestive radiologic image and a reassuring clinical picture, one can recommend a simple medical treatment (1 recovery) and propose a steady radiologic surveillance. In case of doubt or hematuria, it is preferable to advocate surgical investigation: 2 patients out of the 3 showing a hematuria, were operated on, the third having refused. In one case, hematuria was due only to cystic uretero-pyelitis, while the second was known to have a vesical tumor with C.U.P. The real danger, in presuming a cystic uretero-pyelitis, is the failure to recognize a ureteral papillomatosis, hence the necessity of radiologic surveillance. The authors did not note any serious bilateral form. The only bilateral involvement seen in the 7 cases was not accompanied by reanl deficiency.