[Is statin use associated with D'Amico risk groups and biochemical recurrence after radical prostatectomy?]. / Impact de la prise de statines sur les groupes à risques de progression de D'Amico et la survie sans récidive biologique après prostatectomie totale.

OBJECTIVE: To examine the association between statin use and prostate cancer (PC) stratified with D'Amico risk groups and biochemical recurrence (BR) in patients undergoing radical prostatectomy (RP). PATIENTS AND METHODS: All medical charts of patients managed from 2004 to 2008 for PC with RP were reviewed retrospectively. The use and the type of statin were identified. Patients were split according to the use (S+) or not (S-) of statin. The two groups were compared using the Chi(2) test. A logistic regression was performed for multivariate analysis. RESULTS: Overall, 377 patients were included. Mean age was 64 (48-76) (median, range). Ninety-seven patients (27.5%) used statin for at least a year. Groups S- and S+ were comparable in terms of age, obesity, diabetes, preoperative PSA, biopsy Gleason score or clinical stage. The use of statin was statistically associated with D'Amico risk groups (P=0.003). The number of high-risk PC was higher in Group S+ (23.7% vs. 10.7%) with an odds ratio of 2.4 (P=0.009). With a mean follow up of 33±10 months, the overall 2-years-BR was 89%. The 2-years-BR was higher in the S+ (93% vs. 88%, P=0.16). After adjustment, this difference was statistically significant with a hazard ratio of 0.46 (P=0.036). CONCLUSION: The use of statin was associated with high risk PC in this study. Surprisingly, the statin use seem also to be associated with better disease-free survival, independently of other risk factors.

Trans-rectal ultrasonography (TRUS) with lipiodol injection for localization of the prostatic apex before radiotherapy planning.

PURPOSE: To evaluate reliability of Trans-rectal ultra-sonography (TRUS) guidance with lipiodol injection for prostate localization before radiotherapy planning. MATERIAL AND METHODS: From October 1997 to March 2000, 31 patients with prostatic adenocarcinoma and six patients with anastomotic recurrence after radical prostatectomy had TRUS-guided injection of lipiodol. Two milliliters of lipiodol were injected into each side of the prostate and 1 ml into both seminal vesicles with a 22 Gauge CHIBA needle and US probe guide before radiotherapy planning. We had established a contrast quality index (0 for no prostate enhancement to 5 for efficient pacification without any diffusion). On simulation films, we had performed anatomic measurements for comparison with other anatomic studies. RESULTS: For all 37 patients, TRUS-guided injection was well tolerated. Among 31 patients with the prostate in situ, three had no apex opacification and 15 had no vesicle enhancement or peri-vesicle space diffusion. However, in 19 patients there was good contrast quality with an index score of > or =3. The majority of patients had prostatic apex between 1.5 and 3.5 cm from ischial tuberosities ligne (27 from 28 evaluable for apex). Among 19 evaluable patients, 15 had seminal vesicles 2-4 cm above the top of pubis. For six patients with anastomotic recurrence after radical prostatectomy, lipiodol was precious aid to locate it. We had only one failure because of a precocious bladder absorption relating to a delay which is too long between rectal probe locating and portal films. CONCLUSION: TRUS injection of lipiodol is a simple, inexpensive, relatively safe technique for localization of prostatic apex, but not appropriate for seminal vesicles enhancement. This is also an interesting method to locate anastomotic recurrence.

[A massive bone metastasis of prostatic origin (author's transl)]. / Une métastase osseuse exubérante d'origine prostatique.

The authors report the case of a 68 year old man with histologically proven cancer of the prostate who progressively developed an ischioperineal tumor interfering with sitting, and in the pelvis x-ray it was ovular measuring 16 X 7.5 cm. This bone tumor, developed at the expense of the right ischeopublic ramus and the ischeal tuberosity, was well limited and circumscribed, with its central portion dense and the periphery giving a septate appearance. The biopsy of the tumor done under a brilliance amplifier showed that it was an osteosclerotic metastasis of an adenocarcinoma. It appears exceptional for a prostatic cancer metastasis to occur in such an expansive and massive form.

[Predicting prostate cancer with dynamic endorectal coil MR and proton spectroscopic MR imaging]. / Détection du cancer de la prostate par IRM endorectale dynamique et spectroscopique-proton.

PURPOSE: Determine the feasibility of dynamic gadolinium enhanced MRI and spectroscopic imaging in routine clinical practice using standard equipment and its usefulness for patients with negative biopsies and high degree of suspicion of prostate cancer. PATIENTS AND METHODS: Fifty five patients underwent endorectal MRI using T2W spin echo (SE) imaging, dynamic gadolinium enhanced imaging and proton spectroscopic imaging before repeat US-guided transrectal biopsies. The statistical analysis consisted in the correlation of the results obtained with each of the two MRI techniques and the results of the biopsies in the corresponding prostate lobe. RESULTS: 32 patients were included in the analysis. Biopsies revealed cancer for 15 patients. The statistical analysis showed a lack of significant correlation between T2W-SE imaging and biopsy results. A correlation with statistical significance was found between dynamic gadolinium enhanced imaging and biopsies (p=0,0018) and between spectroscopic imaging results and biopsies in the corresponding lobe (p=0,0001). CONCLUSION: Endorectal MRI with a standard clinical equipment using dynamic gadolinium enhanced imaging and spectroscopic imaging may be used in clinical routine to improve detection and localization in prostate cancer compared to T2 weighted spin echo imaging.

[Pregnancy in renal transplant patients]. / Grossesse chez les transplantées rénales.

Renal transplantation is compatible with pregnancy in women under permanent dialysis, and leads to no problems for the mother or the transplant. The seven pregnancies observed in the authors' center over the past fifteen years progressed satisfactorily. There were no rejections, no cases of renal failure. In two cases, however, there was an aggravation of hypertension with acute gravidic toxemia and spontaneous abortion. The effects on the fetus of immunosuppressive drugs are difficult to evaluate; the main risk is prematurity.

[Role of echotomography in the diagnosis of renal masses. Comparative study with computerized tomography, arteriography and anatomopathological studies (100 cases)]. / Place de l'échotomographie dans le diagnostic des masses rénales. Etude comparative avec la tomodensitométrie, l'artériographie et l'examen anatomo-pathologique (cent cas).

The authors have selected a series of 100 recent cases of solid and fluid-filled tumors, all of which were explored by nephro-urotomography and ultrasound. These two procedures constituted the basis of the examination. In case of doubt, they had recourse to CT scans. They consider that arteriography is likely to become exceptional.

[Primary vesical pneumaturia in the absence of diabetes (author's transl)]. / Pneumaturie vésicale primitive en dehors du diabète.

Vesical pneumaturia occurring in the absence of any glycosuric diabetes suggested a uro-digestive origin. The pathogenesis of primary pneumaturia, in the absence of diabetes, is discussed on the basis of experimental research. The aetiopathogenic mechanism of this primary pneumaturia remains obscure.

[Multilocular cyst of the kidney (author's transl)]. / Kyst multiloculaire du rein.

The authors report the 67th published case of multilocular renal cyst, noting that half of the published cases concerned children. Left lumbar pain led to the discovery of a palpable mass of the lower pole of the left kidney visible at urography. At echotomography, alternation between dense and fluid areas made it possible to eliminate a solitary cyst. Renal arteriography was disturbing by virtue of the persistent slight peripheral hypervascularisation after the injection of angiotensin. Diagnostic doubt and the absence of any clearly defined limit between healthy kidney and pathological kidney led to nephrectomy. Histopathology : a thick capsule separated from the healthy kidney a series of cystic structures with no intercommunication between them, nor with the excretory system. Each cyst was lined with an endotheliform single layer epithelium with no renal tissue in the intercystic fibrous separations. The authors emphasise the difficulty of offering an opinion as to the aetiopathogenesis of this lesion which certain feel to be a dysplasia and others as a transitional form with nephroblastoma.

[Bilateral ureteral metastases, a 1st symptom of gastric cancer. Gastrectomy. Bilateral ureteral replacement]. / Métastases urétérales bilatérales, premier symptôme d'un cancer gastrique. Gastrectomie. Remplacement urétéral bilatéral.

Renal colic in a young adult led to the discovery of very extensive bilateral ureteral stenosis. Exploration and biopsy showed metastatic lesions of an asymptomatic gastric cancer. Gastrectomy and subtotal bilateral ureteral replacement by prosthesis gave excellent short term results.

[Marshall-Marchetti-Khrantz operation for stress incontinence. 100 cases (author's transl)]. / Intervention de Marshall-Marchetti-Khrantz au cours des incontinences à l'effort. A propos de 100 cas.

The authors report a series of 100 cases of stress incontinence of urine in the woman, treated by Marshall-Marchetti-Khrantz operation. In reoperations for urinary incontinence which has already been treated surgically, the authors deliberately opened the bladder in order to clearly visualise the bladder neck and trigone and hence insert the juxta-cervico-urethral sutures in the best possible position. It is of interest to note the severity of Retzius haematomas (even though rare: 3 cases) and the risk of transfixion of the excretory system by a suture which leads to the development of bladder lithiasis. It is above all of interest to note the absence of prolonged dysuria. Results were excellent and may be viewed in three main areas: 1) Patients undergoing their first operation: 76 cases, 70 successes, i.e. 92.2%. 2) Patients undergoing reoperation: 16 cases, 13 successes, i.e. 82%. 3) Finally, neurological bladders: 8 cases with 4 failures. The authors draw the conclusion that neurological bladder with urinary incontinence is a poor indication for incontinence surgery. By contrast, the results of primary or secondary operations appear to be good and they are encouraged to continue. Failures of this operation are due either to an inappropriate indication or essentially to technical errors leading to the breaking away of vaginal fixation: Retzius haematoma, Retzius abscess, the use of absorbale sutures and finally late breakdown. It must nevertheless be noted that deteriorations occurred up to the 2nd postoperative year. In the literature, the authors found reports of non-negligeable deterioration occurring late in a certain number of published series.

Radiologic features of a metastatic carcinoma to the ureter.

2 cases of metastasis to the ureter from carcinoma of the stomach are presented. The clinical and radiologic features are reviewed. Metastasis to the ureter is rare. A plea for vigorous evaluation and early detection of this entity is made.

[Pelvic lipomatosis: value of x-ray computed tomography. Apropos of a case]. / Lipomatose pelvienne: intérêt de la tomodensitométrie. A propos d'un cas.

Pelvic lipomatosis is characterised by an excessive amount of adipose tissue in the pelvis. Although there are usually few clinical symptoms, the radiological changes are characteristic: pear-shaped bladder, straightened and displaced rectosigmoid junction. However, these changes are not specific and some workers advise histological confirmation with or without surgical exploration. The authors describe a case illustrating the diagnostic value of computerised axial tomography, as has previously been reported. This investigation seems to give reliable results in the diagnosis of pelvic tumours, especially those of adipose tissue.