[A complex case of miliary pulmonary tuberculosis following intravesical BCG therapy]. / Un cas complexe de miliaire pulmonaire post-BCG thérapie pour carcinome urothélial.

Bladder cancer (urothelial carcinoma in 90 % of cases) is the most common neoplasia of the urinary tract. Superficial carcinoma represents 70-80 % of bladder cancers. The treatment of these tumours includes, after transuretral resection, intravesical Bacillus Calmette-Guerin (BCG) instillation therapy. This treatment constitutes, by its immune-mediated anti-tumoral action, the first step of immunotherapy in cancer. Severe complications (granulomatosis, hypersensitivity pneumonitis or orchitis) are rare (0.5-2 %). Here we report a complex case of pulmonary granulomatosis secondary to BCG therapy. This is a 74-year-old male, treated for superficial bladder carcinoma by transuretral resection (pT1G3) and then endovesical instillations of BCG therapy for two months. Two years later, a new transuretral resection shows an infiltrating urothelial carcinoma pT2G3. The extension balance finds a persistent micro-nodular pulmonary infiltrate. A broncho-alveolar lavage is then realised but no mycobacteria was found. A surgical biopsy of a nodule is performed and revealed a histiocytic reaction without any neoplastic element. Detection of Mycobacterium tuberculosis by Polymerase Chain Reaction (PCR) was finally positive. In the absence of a secondary lesion, the patient had a cysto-prostatectomy and began a tritherapy against tuberculosis. Post-BCG therapy granulomatosis is a rare complication but should remain a differential diagnosis in front of the appearance of pulmonary nodes in patients who have received posttransuretral resection BCG instillations. Mycobacterial DNA PCR research remains the most sensitive examination.

Les carcinomes urothéliaux superficiels de vessies représentent 70 à 80 % des tumeurs de la vessie. Leur traitement comprend, après résection transurétrale, une BCG (Bacille de Calmette et Guérin) thérapie par instillations endovésicales. Les complications sévères (granulomatose, pneumopathie d'hypersensibilité ou orchite) sont rares (0,5-2 %) mais nous rapportons ici un cas complexe de granulomatose pulmonaire secondaire à une BCG thérapie. Il s'agit d'un homme de 74 ans, traité pour un carcinome urothélial superficiel de vessie par résection endo-urétrale (pT1G3) puis instillations endovésicales de BCG thérapie. Deux années après, une nouvelle résection transurétrale objective un carcinome urothélial infiltrant pT2G3. Le bilan d'extension retrouve un infiltrat pulmonaire micronodulaire persistant. Un lavage bronchoalvéolaire ne retrouve pas de bacilles acido-alcoolo-résistants. La biopsie chirurgicale d'un nodule retrouve une réaction histiocytaire sans élément néoplasique. La Polymerase Chain Reaction (PCR) à la recherche de mycobactérie du groupe tuberculosis revient finalement positive. En l'absence de lésion secondaire, le patient a bénéficié d'une cystoprostatectomie et a débuté dans les suites une trithérapie antituberculeuse. La granulomatose post-BCG thérapie est une complication rare, mais doit rester un diagnostic différentiel devant l'apparition de micronodules pulmonaires chez les patients ayant reçu des instillations de BCG post-résection transurétrale. La recherche par PCR d'ADN de mycobactéries reste l'examen le plus sensible.

Modelling the rheological properties of sludge during anaerobic digestion in a batch reactor by using electrical measurements.

Anaerobic digestion is a significant process leading to biogas production and waste management. Despite this double interest, professionals still face a lack of efficient tools to monitor and manage the whole procedure. This is especially true for rheological properties of the material inside the reactor, which are of major importance for anaerobic digestion management. However, rheological properties can hardly be determined in-situ and it would be very helpful to determine indicators of their evolution. To solve this problem, this paper investigates the evolution of sewage sludge rheological and electrical properties during the anaerobic digestion in a batch reactor. We especially focus on apparent viscosity and complex impedance, measured by electrical impedance spectroscopy. Both of them can be modelled by a linear combination of raw sludge and inoculum properties, weighted by time-dependent coefficients. Thus, by determining digested sludge electrical signature, it is possible to obtain those coefficients and model sludge apparent viscosity. This work offers many theoretical and practical prospects.

[How to evaluate the cost/effectiveness ratio of different therapies of coronary disease]. / Comment évaluer le rapport coût/efficacité des différentes thérapeutiques de la maladie coronarienne.

The results of epidemiologic studies on the efficacy of different strategies of prevention or improvement of the prognosis of coronary artery disease are generally expressed in terms of percentage reduction of risk; for example, the treatment of hypercholesterolaemia reduces the risk of coronary death by 21%. In order to improve the assessment of the efficacy of these approaches the authors propose to take into account the number of subjects which needs to be treated each year to prevent one cardiovascular event more than the control group (for example, in hypercholesterolaemia, 1,736 patients). This number depends on the reduction of risk and also on the incidence of complications in the control group. Using this method, the authors classified different therapeutic strategies in order of their efficacy: thrombolytic therapy in the acute phase of myocardial infarction, then aortocoronary bypass grafting of left main coronary or triple vessel disease, secondary prevention with stopping smoking, and betablocker therapy. Finally, primary prevention with anti-smoking campaigns, treatment of hypertension and hypercholesterolemia. Based on this figure and knowing the annual cost of patient treatment, it is possible to calculate a cost-effectiveness ratio for each of these therapeutic interventions.

[Urinary fistula after renal transplantation]. / Les fistules urinaires après transplantation rénale.

Among 336 consecutive renal transplantations performed in our centre from March 1979 to December 1988, we have observed 26 cases of urinary leak in 25 patients. We have separated the ischemic and non-ischemic urinary leaks. The former (11 episodes) would have been prevented in most cases with better graft removal. The latter (15 episodes) were predominantly secondary to an anastomotic leak. We have treated surgically these urological complications. Only one patient died. The one-year graft survival rate was 67% in the 25 kidneys but the graft loss was directly due to the urinary leak in three cases.

[Pyelo-ureteral junction syndrome in a transplanted kidney]. / Syndrome de jonction pyélo-urétérale sur un rein transplanté.

The authors report a case of decompensated pyelo-ureteric junction obstruction in a renal transplant patient with anuria on the 27th day, while the IVP (on the 22nd day) was normal. They compare this case with the literature.

[Transplantation and tumors of the kidney]. / Transplantation et tumeurs du rein.

The authors report the case of a woman who was transplanted with a cadaveric kidney. It was a cyst on the kidney; a biopsy was performed: it was a carcinoma. The transplanted kidney was removed. The second case was a man, transplanted with a cadaveric kidney, with a tumor at the lower pole: a tumorectomy was performed: it was a angiomyolipoma.

[Ureteral stenosis in kidney transplantation]. / Les sténoses urétérales en transplantation rénale.

The authors report 13 cases of ureteral or periureteral sclerosis in a series of 330 cases of renal transplantation (3.9%): they occurred early, were asymptomatic (except for anuria); the renal cavities were always dilated, the renal function always deteriorated; the treatment was essentially surgical without mortality and with a low complication rate but 23% of the transplants were lost because of urological complications at 18 months. The authors compare their series with the literature.

[Emphysematous pyelonephritis]. / Pyélonéphrite emphysémateuse.

The authors report on a case of a emphysematous pyelonephritis due to Klebsiella pneumoniae, occurring in a diabetic patient and successfully treated by nephrectomy. They compare it to the literature.

[Recurrent bladder calculi after colpocystopexy]. / Lithiase vésicale récidivante après colpocystopexie.

The authors report a case of bladder stones after urethro-vesical suspension, due to non absorbable suture material in the bladder. After surgical treatment, new stones were found, removed transurethrally with a good result after two years.

[Urinary calculi caused by glaphenine. Role of radiology in diagnosis. Apropos of a case]. / Les lithiases urinaires dues à la glafénine. Place de la radiologie dans le diagnostic. A propos d'un cas.

The authors report a case of urinary calculi secondary to glafenine which posed a difficult problem in the radiological diagnosis. They review the literature of iatrogenic urinary calculi and discuss the place of radiology (Excretory Urography, Ultrasound and Computed Tomography) in the diagnosis.

Renal transplantation and Kock pouch: a case report.

We report on a young woman with anuric, terminal renal insufficiency whose bladder could not be used for renal transplantation. A Kock pouch was implanted during stage 1 of treatment and the capacity of the pouch was increased artificially with physiological saline solution. The patient subsequently underwent renal transplantation. Results were excellent with regard to continence and ease of catheterization. No complications due to infection were observed despite immunosuppression and electrolyte disorders were minor.

[Arterial hypertension with renin hypersecretion secondary to pyelo-ureteral syndrome. Cure after corrective surgery]. / Hypertension artérielle avec hypersécrétion de rénine secondaire à un syndrome de la jonction pyélo-urétérale (SJPU). Guérison après chirurgie correctrice.

In a 22 years old woman with recent hypertension, a timed intravenous pyelogram revealed an asymptomatic obstructive ureteropelvic junction. Preoperative renal vein catheterization demonstrated excessive renin release from the diseased kidney and low release from the other one, suggesting that corrective ureteral surgery should return blood pressure to normal levels. Moderately impaired glomerular filtration rate improved after surgery as a consequence of suppressed hydronephrosis and bilateral renal ischemia. Thus we conclude that in young people, asymptomatic unilateral hydronephrosis can lead to hypertension and renal failure like renal artery stenosis. In the other cases of urinary flow obstruction, secondary hypertension remains to be explained by both inappropriate production of renin and water chronic retention.

[False positive urinary cytology. Diagnostic and prognostic value in the detection and surveillance of urothelial tumors. Apropos of 57 false positive cases in a series of 1000 cytologies]. / Les cytologies urinaires "faussement positives". Valeur diagnostique et pronostique dans le dépistage et la surveillance des tumeurs urothéliales. A propos de 57 cas de "faux positif" sur une série de 1,000 cytologies.

Out of 1,000 optical cytological urine tests carried out over a period of two years, 84 isolated cases were "positive" and alerted 57 patients. These cases are analyzed by the authors with a follow-up period of 48 to 72 months: among those patients already under supervision for urothelial tumours, 40.4% showed urothelial recurrence of which 70%, that did not appear to carry a worse prognosis, were detected in the first twelve months. Since these patients usually underwent annual endoscopic examination, this meant that for 20% (i.e. 4.15% of the group under supervision) the diagnosis of recurrence could be made at least 6 months earlier. This alone is a justification for cytological examination which does not involve any complications but merely entails increased cystoscopic and biopsy tests. On the other hand, there appear to be no grounds to advocate mass "screening" except in populations with warning symptomatology (especially haematuria) for which the ratio of positive findings in this series was 2.3/1,000. The future development of automatic apparatus for cytological tests should obviate the significant personal factor involved in cytological examinations, as shown by a review of the literature.

[Suspended ileo-ureteroplasty following appendiculoplasty]. / Iléo-urétéroplastie suspendue faisant suite à une appendiculoplastie.

The authors report on a case of a stenosis of a uretero-appendiculoplasty, treated by an ileal suspended loop, with a good result.

Accumulation of glycolic acid and glyoxylic acid in serum in cases of transient hyperglycinemia after transurethral surgery.

Experimental data are presented here proving the accumulation of glycine in serum after transurethral prostatectomy and increased production of glycine metabolites: serine, alanine, glyoxylic acid, and glycolic acid. The presence of the metabolites glyoxylic acid and glycolic acid was demonstrated by gas-liquid chromatography and mass spectrometry. Glycine, glyoxylic acid, and glycolic acid possess neurological activity, so we examined the pathophysiology of the transurethral prostatectomy syndrome in view of the transient accumulation of these compounds in serum.

[Hydatid cyst of the kidney rupturing in the kidney pelvis and associated with lithiasis. Apropos of a case]. / Kyste hydatique du rein fissuré dans le bassinet et associé à une lithiase. A propos d'un cas.

The authors report one case of renal hydatid disease, with lithiasis and rupture into the renal pelvis. Pre-operative diagnostic investigation included ultrasound and CT scan imaging. Serologic test was negative. Treatment was surgical: removal of the hydatid and resection of the protruding part of the cyst. The fistula is closed with a drainage into the pelvis.

[Early graft venous thrombosis after renal transplantation (2 cases)]. / Thrombose veineuse précoce du greffon après transplantation rénale (deux cas).

The authors report two cases of early transplant renal vein thrombosis after kidney transplantation. In the two cases, the graft had to be removed. Many difficulties prevented the diagnosis of this fortunately unusual (0.8% of all transplantations performed) vascular injury.

[Ureteral stenosis following colpocystopexy of urinary stress incontinence. Apropos of 5 cases]. / Les sténoses urétérales après colpocystopexie pour incontinence urinaire d'effort. A propos de 5 cas.

The authors report 5 cases of a rare urethrovesical suspension's complication = the ureteral obstruction. Its cause is always a surgical fault, its diagnosis is based on urography. Its treatment is surgical. The kidney can be preserved by an early repair; the continence's preservation is possible when the suspension can be preserved.