[Treatment of idiopathic varicocele: comparative study of three techniques about 128 cases]. / Traitement de la varicocèle idiopathique : Étude comparative de trois techniques à propos de 128 cas.

BACKGROUND: Several modalities of varicocele treatment are available, however, no therapeutic technique showed its superiority with regard to the other one. AIM: To compare the results of three techniques of varicocelecomy. METHODS: Retrospective Analytical and comparative study of 128 patients treated by of three techniques of varicocelectomy: the open surgery by retro peritoneal way for 42 patients (GI), the varicocelectomie coelioscopique for 41 patients (GII) and the antegrade scrotal sclerotherapy done for 45 patients (GIII), between march 2001 and January 2009.The mean age was 28 years. The main motive for consultation was represented by the painful varicocele in 67 % of the cases, followed by the hypofertility in 20.3 % of the cases and the association both in 12,5 % of the cases. The varicocele was in leftsider in 71.1 % of the cases, to the right side in 5.4 % of the cases and was bilateral in 23.43 % of the cases. Varicocele was infra-clinical at 6 patients, grade 1 in 16 sides, grade 2 in 105 sides and grade 3 in 31 sides. The numeration, the mobility as well as the morphology of sperm cells were comparable between the three groups Results: The global rate success was 81.2 %, with the highest rate found in the group III which was treated by antégrade scrotal sclerotherapy (84.4 %). The improvement of the parameters of the spermogramme was noted in the three groups, however a statistically significant difference was found only in patients treated by antégrade scrotal sclerotherapy; it mainly concerned numeration and the mobility of spermatozoides. The highest rate of pregnancy was recorded in patients treated by antégrade scrotal sclerotherapy (13.3%). The main postoperative complications were hydrocele (16%) followed by testicular hypotrophy (3 patients). CONCLUSION: Three techniques of varicocele treatment, offer either a similar success rate, and improvement of parameters of the sperm cells. However, antegrade scrotal sclerotherpy seem to be the best treatment of first intention in proposed, regarding its efficiency, of the ease of its realization, its moderate cost and its feasibility in case of recurrence if varicocele was treated with open way'GIII).

Atypical form of melorheostosis improved by pamidronate.

BACKGROUND: Melorheostosis is a rare chronic bone disease of unknown etiology that often affects a single limb. AIM: Report a new case of melorheostosis of the ribs improved by pamidronate infusions CASE: A 36-year-old man without any medical history was admitted for a history of one month painful tumefaction on the 7th left rib. The diagnosis of melorheostosis of the rib and the tibia was made. Patient was treated by pamidronate infusions with useful and satisfactory outcome.

[Pseudoxanthoma elasticum, 5 case reports]. / Pseudoxanthome élastique, 5 observations.

INTRODUCTION: Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease with many systemic manifestations. We report 5 cases. OBSERVATIONS: The first patient presented cutaneous (yellowish grouped papules with reticulate pigmentation) and ocular manifestations (angioid streaks). The second patient is the sister of the first and presented the same clinical signs. The third is the mother of the two previous patients. The diagnosis of PXE was made on using a skin biopsy of healthy skin during family screening. The fourth patient presented yellow grouped papules with cutaneous hyper-elasticity and angioid streaks. The fifth patient presented essentially cardiovascular symptoms: arterial hypertension, total aortal dilation, arteriopathy and a cerebral vascular accident. DISCUSSION: Cutaneous manifestations are frequent (70 to 85%). Ocular signs are associated with the cutaneous signs in around 90% of PXE. The vascular lesions condition the vital prognosis. The gold standard of diagnosis is skin biopsy taken from damaged skin but it can also be positive even in normal skin (cases 3 and 5). Our series is characterised by the existence of unusual clinic manifestations of PXE: reticulated pigmentation and total aortal dilation. CONCLUSION: The PXE is a rare metabolic disease whose diagnosis is classically histopathological. Nowadays, molecular diagnosis is also possible.