[Surgical treatment of pancreatic metastases from renal carcinoma]. / Traitement chirurgical des métastases pancréatiques des cancers du rein.

OBJECTIVES: Pancreatic metastases from renal carcinoma are poorly known. The aim of this study was to report clinical and radiological manifestations, the treatment performed, and the observed survival in 7 patients with this rare entity. RESULTS: All patients were operated on. One patient had nonresectable tumor. Six patients underwent curative resection. There was one postoperative death. Follow-up after pancreatectomy ranged from 6 months to 3 years. Two patients developed extra-pancreatic metastases one year and 3 years after pancreatectomy respectively. CONCLUSIONS: Pancreatic metastases from renal carcinoma are rare and often occur several years after nephrectomy. However their resection is often possible and allows a good long-term survival. PATIENTS AND METHODS: From 1988 to 2000, 7 patients (5 men and 2 women, mean age = 66 years) with pancreatic metastases from a renal cell carcinoma were observed in the same center. One patient had synchronous metastasis; in the 6 others, metastases were diagnosed 4 to 16 years after nephrectomy, and were revealed by pain (n = 2), gastrointestinal bleeding (n = 1), faintness (n = 1) or routine follow-up (n = 2). The diagnosis of metastases was made by contrast-enhanced abdominal CT-scan.

[Value of cytological study by flow cytometry or analysis of image as a complement to macroscopic study by cytoscopy. Apropos of therapeutic follow-up of a case of tumor of the bladder]. / Intérêt de l'étude cytologique par cytométrie en flux ou analyse d'image en complément de l'examen macroscopique par cystoscopie. A propos du suivi thérapeutique d'un cas de tumeur de vessie.

The case described corresponds to a grade G2 urothelial tumor with stage pTa extension (according to the World Health Organisation classification). After transurethral resection of the tumor and treatment by Bacillus Calmette Guerin (BCG), the efficacy of treatment was evaluated by cystoscopy, standard cytology, flow cytometry or image analysis. According to these various methods it has been shown that a normal cystoscopy may or may not be associated with aneuploidy revealed by flow cytometry. Such a case clearly illustrates the value of combining macroscopic examination and a cytologic analysis in particular by flow cytometry in order to increase the accuracy of diagnosis and to evaluate without ambiguity the efficacy of treatment.

Characterization of seven kidney tumors by flow cytometry: analysis of cell cycle, DNA content and P-glycoprotein expression.

Seven kidney tumors obtained from patients aged from 5 to 76 years were analyzed by flow cytometry for cell cycle, DNA content and P-glycoprotein expression involved in multidrug resistance. The DNA index seems to be an important criterion since all the tumors were aneuploid. In a case of clear cell carcinoma, two aneuploid clones were identified. In 5 cases of kidney tumors a high proportion of cells in proliferation (S + (G2 + M)) was observed; it was comprised between 13 and 33%. As for P-glycoprotein it was detected only in few tumor cells (5-15%) respectively in a case of clear cell carcinoma and in a case of Wilms' tumor.

Non-Hodgkin's lymphoma of the urethra: a rare extranodal entity.

We report a rare case of non-Hodgkin's lymphoma of the urethra in a female patient. A review of the literature showed that all such reported cases were described in females, were of varying histologic grade, and presented as a polyp or caruncle. Whether this entity is often localized and has the excellent prognosis of early carcinoma of the urethra will have to be determined by study of more cases.

[Prostatic tumors. Detection by proton nuclear magnetic resonance spectroscopy of plasma lipoproteins]. / Tumeurs prostatiques. Détection par spectroscopie de résonance magnétique nucléaire protonique des lipoprotéines plasmatiques.

Recently, there has been interest over detection of malignant tumors by water-Suppressed Proton Nuclear Magnetic Resonance Spectroscopy (1 HNMR) of plasma lipoproteins (N. Engl. J. Med., 1986, 315, 1369-76). We performed a similar prospective and blinded study comprising 75 subjects; 40 control (C), 15 untreated prostate cancer patients (PC) and 20 patients with benign prostate tumors (BT). We measured the parameter W 1/2, as mean of the full width at half height of the resonances of the methyl and methylene groups of the lipids of the plasma lipoproteins which is inversely related to the spin-spin apparent relaxation time (T2*). W 1/2 values were determined at a fixed baseline of 310 Hz. The W 1/2 mean values were 37.6 +/- 3.7 Hz for C, 37.4 006 5.2Hz for PC and 36.4 +/- 3.9 Hz for BT, essentially identical for all three groups. Furthermore, no difference was seen between any group on scatter pattern that could serve as a basis for a useful detection test. The major difficulty in the determination of W 1/2 was due to interference of metabolite protons (lactate) within the lipoprotein resonance signal. There was no correlation seen between W 1/2 triglyceride, total cholesterol, HDL-cholesterol and (LDL + VLDL)-cholesterol levels. We conclude the Water-Suppressed 1HNMR Spectroscopy of plasma lipoproteins as performed, is not a valid method for detection of prostate cancer.

[Superficial bladder tumors. Results of preventive treatment of recurrence by intravesical instillation of BCG]. / Tumeurs vésicales superficielles. Résultats du traitement préventif des récidives par instillations endovésicales de BCG.

Two-thirds of newly diagnosed bladder tumors are superficial transitional cell carcinomas. Local relapses occur in more than 2/3 of the patients after transurethral resection of the initial tumor, with a risk of muscle invasion in 1/3 of them. A retrospective study of 100 consecutive patients was performed to assess the role of intravesical BCG-therapy as a prophylaxis against the recurrence of superficial bladder cancer; the treatment protocol is described. Eighty-two patients had previously had recurrent tumors and 18 were given BCG directly because they had multiple, large, high grade or widespread tumors. Seventy patients (70 p. 100) tolerated the treatment well, but 6 experienced serious complications (3 systemic BCG infections and 3 bladder contractures). Of the 18 patients given BCG after their first tumor, 12 (66 p. 100) are tumor-free with a mean follow-up of 13 months. Of the 82 patients with previous recurrent tumors, 52 (63 p. 100) were improved by the treatment. Of the 100 patients, twelve tumors became muscle invasive and required more aggressive intervention. Intravesical BCG is effective in preventing recurrences of superficial bladder cancer. However, the side effects and the risk of muscle invasion require close monitoring.

[Trans-trochanteric vesico-cutaneous fistula after total hip replacement]. / Fistule vésico-cutanée trans-trochantérienne aprés prothése totale de hanche.

Urological complications following hip arthroplasty occur infrequently. We report another case of vesico-cutaneous fistula due to migration of methyl methacrylate cement into the pelvis.

Proton nuclear magnetic resonance spectroscopy of plasma lipoproteins in malignancy.

A recent study (N. Eng. J. Med. 315 (1986), 1369), described a method of detecting malignant tumors by water-suppressed proton nuclear magnetic resonance (1 H NMR) study of plasma. We performed a similar study of the W 1/2, a mean of the full width at half height of the resonances of the methyl and methylene groups of the lipids of plasma lipoproteins which is inversely related to the spin-spin apparent relaxation time (T 2*). W 1/2 values were measured at a fixed baseline width of 310 Hz. The study was prospective and blinded and comprised 182 subjects consisting of 40 controls, 68 patients with untreated malignancies, 45 with malignant tumors undergoing therapy and 29 benign tumor patients. No differences were seen between any groups that could serve as a basis for a useful clinical test. The major difficulty in the determination of W 1/2 was due to interference of metabolite protons (particularly lactate) within the lipoprotein resonance signal. Triglyceride level was seen to correlate inversely with W 1/2 within malignant patient groups. These discrepant results may be related to differing triglyceride-rich very low density lipoprotein (VLDL) levels in the patient populations of each study. We conclude that the water-suppressed 1H NMR of plasma lipoproteins is not a valid measurement for assessing malignancy.

[Does the antireflux operation promote growth of the kidneys? Apropos of 65 surgically treated children with a minimal follow-up of 4 years]. / L'opération antireflux favorise-t-elle la croissance des reins? A propos de 65 enfants opérés avec un recul minimum de quatre ans.

A study in 65 children followed up over at least 4 years after Cohen's operation evaluated renal growth rate using Eklof and Ringertz method. Analysis showed that: small kidneys with corticopapillary lesions were all atrophied; hypertrophic kidneys remained hypertrophic or were within a normal growth rate range; normal size kidneys never hypertrophied but atrophied in 13.5% of cases; the presence of corticopapillary lesions multiplied the risk of degradation of a normal size kidney by a factor of 5.5. These findings are in concordance with documented data, only Willscher et al finding accelerated renal growth rate after surgical relief of reflux.

[Ureterosigmoidostomy with antireflux in children. Apropos of a short series]. / L'urétérosigmoïdostomie avec antireflux chex l'enfant. A propos d'une courte série.

Ureterosigmoidostomy with anti-reflux technique (Petit-Leadbetter procedure) was performed in 12 children, mainly after failure to repair an exstrophy. After a mean follow up of 45 months, results were assessed as good from clinical and urographic points of view, although there were 3 possible cases of reflux, one of anastomotic stenosis (operated upon with success) and one of moderate continence only. An anastomotic tumor was not detected, but follow up is of moderate duration only. This operation should be reserved for a limited number of cases: those with irreparable exstrophy and those in whom a skin bypass is unacceptable.

[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.

[Adenocarcinoma of prostate in adolescents and young adults. Apropos of a case in a 20-year-old man]. / L'adénocarcinome de la prostate de l'adolescent et l'adulte jeune. A propos d'une observation chez un homme de 20 ans.

A new case of adenocarcinoma of the prostate in a 20 years old man is described. Data from the literature and treatment modalities are discussed in this patient who successively received hormonotherapy, radiotherapy and chemotherapy. An exceptionally long survival has observed in this patient who is surviving in good edition 5 years after the diagnosis.

Cefotaxime in combination with other antibiotics for the treatment of severe methicillin-resistant staphylococcal infections.

Methicillin-resistant staphylococci (M-R staphylococci) represent 30% of the staphylococcal strains isolated in our hospital and pose important therapeutic problems. In a preliminary in vitro checkerboard study the bactericidal effect of various cephalosporins (cephalothin, cefamandole, cefotaxime and cefoperazone) in combination with other antibiotics (netilmicin, amikacin, vancomycin and fosfomycin) was studied on ten M-R staphylococcal strains. The combinations of cefoperazone with amikacin, cephalothin with vancomycin and of the four cephalosporins with fosfomycin were synergistic on the ten strains (FBC indexes less than or equal to 0.75). According to the CSF and bone levels achieved by these antibiotics and their bactericidal concentrations in combination, the combination of cefotaxime and fosfomycin was the most interesting, a concentration of less than or equal to 2 mg/l cefotaxime being bactericidal on five homogeneous M-R Staphylococcus aureus when combined with 4 mg/l of fosfomycin. This combination of cefotaxime (25 mg/kg, i.v. infusion over 30 min) and fosfomycin (50 mg/kg, i.v. infusion over three hours) three to four times daily was used to treat 16 patients: three patients with meningitis, six with bone and joint infections and seven with persistent bacteremia. The FBC indexes were less than or equal to 0.625 for the 12 strains studied. All the patients were cured without relapses. The concentrations of cefotaxime, desacetyl cefotaxime and fosfomycin in the CSF during meningitis three hours after the end of the infusion on the second day of treatment were 8.76, 6.82 and 58.0 mg/l, respectively, for patient one and 2.0, 0.53 and 31.0 mg/l, respectively, for patient two.(ABSTRACT TRUNCATED AT 250 WORDS)

Bactericidal activity of cefotaxime and fosfomycin in cerebrospinal fluid during the treatment of rabbit meningitis experimentally induced by methicillin-resistant Staphylococcus aureus.

The purpose of this study was to evaluate the therapeutic effect of cefotaxime (CTX) and fosfomycin (FOS), alone or in combination, in an experimental meningitis, with cerebrospinal fluid (CSF) concentrations of the two antibiotics reproducing those obtained in human CSF during bacterial meningitis. With a dose of 50 mg/kg of CTX and 100 mg/kg of FOS injected i.v. (CTX over 0.5 h and FOS over 3 h), CSF concentrations were comparable to those observed in man. In a series of five rabbits per treatment group, the bacterial population was counted before and after treatment (two doses with a six-hour interval) with CTX, FOS or CTX + FOS (CTX over 0.5 h before the end of FOS infusion). By the 12th hour of treatment, the percentage of bacteria surviving in CSF compared to the initial population was 4.35% for CTX, 0.20% for FOS and 0.19% for CTX + FOS. Thus, it seemed that CTX + FOS was not more active than FOS alone. In another series of four rabbits per group, the bactericidal effect was followed at T0, T6, T12, T24 and T48 after treatment (two doses with a six-hour with a six-hour interval). With CTX, a variable drop in bacterial count from one rabbit to the other occurred during the first 12 h, and then a bacteriostasis followed. With FOS, a quick bactericidal effect was observed during the first 12 h, becoming slower during the following 36 h (0.03% of bacteria surviving at the 48th hour). With CTX and FOS in combination, a quick bactericidal effect was achieved, remaining steady over a 48-hour period (0.001% of bacteria surviving at the 48th hour).