CAG repeat length in androgen receptor gene and male infertility in Egyptian patients.

The CAG repeat and its association with infertility has been debatable. Therefore, this study was planned to assess the distribution of CAG repeat expansion in Egyptian patients and to investigate its association with male infertility. Forty-five infertile men were eligible for the study in addition to 20 aged-matched fertile males as control. Semen analysis, scrotal sonography, assay of serum testosterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH), and determination of the CAG repeat number within exon 1 of the androgen receptor (AR) gene were carried out. Statistically significant difference was found between infertile and control groups regarding sperm count, sperm motility, serum FSH level and CAG repeats (P < 0.05); statistically insignificant difference for the CAG repeats (P = 1.0) was found between oligozoospermic and asthenospermic groups; negative correlation was found between CAG repeat length and sperm count, and a positive correlation was found between CAG repeat length and serum FSH (P < 0.05). Our results validate the concept that long stretches of CAG repeat may be associated with lower AR function with derangement of sperm production, and this may contribute to male infertility in Egyptian men.

Penile haemodynamic changes in post-radical cystectomy patients.

The aim of this study was to assess the penile vascular changes in post-radical cystectomy patients. A prospective assessment took place between January 2003 and January 2005 of 45 potent men who underwent radical cystectomy and diversion for invasive bladder cancer. Nerve sparing (NS) technique was applied in 21 cases, while others were not subjected to NS (non-nerve sparing group; NNS = 24 cases). All patients were comparable in preoperative clinical and pathological parameters. A control arm was the preoperative normal indices of the same patients. Preoperative penile duplex ultrasounds (PDU) for all cases were carried out, and then follow-up 2, 6 and 12 months thereafter. On first postoperative visit, none of NS cases showed any arterial insufficiency, while two cases of NNS (8.3%) had peak systolic velocity (PSV) < 30 cm/sec. Moreover, all cases of both groups showed early increase of end diastolic velocity (EDV) > 5 cm/sec. In NS cystectomy group, the PSV showed statistically insignificant change [p > 0.05 (mean: 53.6, cm/sec)]. Shortly after surgery, the EDV values increased, followed by gradually significant improvement (decrease in EDV values) in comparison with control state (mean: 5.9 cm/sec). On the other hand, the NNS cases showed statistically insignificant changes in PSV (mean: 49.3 cm/sec), with deterioration in EDV that did not improve with time, in contrast to NS cases (mean: 13.15 cm/sec). The main significant penile vascular changes were in EDV (venogenic mechanism) in post-cystectomy patients. There was a gradual progressive improvement in venogenic competence mechanism in NS cases with insignificant deterioration of arteriogenic mechanism in both groups (NS/NNS).

Selective head cooling and acute kidney injury in neonates with hypoxic ischemic encephalopathy.

BACKGROUND: The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS: Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS: The incidence of AKI as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS: Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. TRIAL REGISTRATION NUMBER: NCT02683915.

[One-stage bilateral rigid ureteroscopy]. / L'urétéroscopie rigide bilatérale au cours de la même séance opératoire.

OBJECTIVE: To evaluate the results of one-stage bilateral rigid ureteroscopy for the treatment of bilateral ureteric stones and to identify predictive factors of failure. MATERIALS AND METHODS: From January 1995 to June 2006, 61 patients were hospitalised for bilateral ureteric stones. Fifty patients, that is, 100 renal units were treated by first-line one-stage bilateral rigid ureteroscopy using an 8 F rigid ureteroscope and a ballistic lithotriptor. A complete statistical analysis (bivariate analysis completed by multivariate analysis) was performed to identify predictive factors of intraoperative failure. RESULTS: The overall success rate per patient (success on at least one side) was 92% (with bilateral success in 70% of cases). Statistical analysis revealed a statistically significant difference between the two failure/success groups for mean stone diameter (p < 0.1%), site (p = 0.6%) and degree of cavity dilatation (p = 4%). Similarly, a strong statistical correlation was observed between these variables and intraoperative failure. The intraoperative complication rate was 4% (two patients) and the postoperative complication rate was 16%, corresponding to minor complications in every case (low back pain, fever) not requiring a supplementary procedure. CONCLUSION: One-stage bilateral rigid ureteroscopy achieved satisfactory results similar to those of unilateral ureteroscopy. Predictive factors of failure were: stone diameter (greater than 15 mm), stones in the lumbar ureter and marked cavity dilatation.

[Intravesical migration of intrauterine device resulting in stone formation]. / Migration intra-vésicale de dispositif intra-utérin compliquée de lithiase.

The migration into the bladder of an intrauterine contraceptive device (IUCD) by uterine perforation is a rare complication. We report two cases of IUCD which migrated into the bladder and subsequently became calcified. The two patients having had their IUCD respectively for 3 and 13 years. Revealing signs were related to bladder irritation for the first patient and hematuria for the second. The diagnosis was suggested on the plain abdominal X-ray and on ultrasound and was confirmed by cystoscopy. Ballistic lithotripsy of the bladder stone with endoscopic extraction of the IUCD was then performed. Performing a transvaginal sonographic examination of the pelvic organs, especially of the uterine anatomy is interesting before insertion of an intrauterine contraceptive device (IUCD), and repeat transvaginal sonographic examinations immediately after the insertion and 4-12 weeks later are advisable. This approach would permit early detection of any complications related to insertion of the IUCD.

Solution structure of the module X2 1 of unknown function of the cellulosomal scaffolding protein CipC of Clostridium cellulolyticum.

Multidimensional, homo- and heteronuclear magnetic resonance spectroscopy combined with dynamical annealing has been used to determine the structure of a 94 residue module (X2 1) of the scaffolding protein CipC from the anaerobic bacterium Clostridium cellulolyticum. An experimental data set comprising 1647 nuclear Overhauser effect-derived restraints, 105 hydrogen bond restraints and 66 phi torsion angle restraints was used to calculate 20 converging final solutions. The calculated structures have an average rmsd about the mean structure of 0.55(+/-0.11) A for backbone atoms and 1.40(+/-0.11) A for all heavy atoms when fitted over the secondary structural elements. The X2 1 module has an immunoglobulin-like fold with two beta-sheets packed against each other. One sheet contains three strands, the second contains four strands. An additional strand is intercalated between the beta-sandwich, as well as two turns of a 3(.10) helix. X2 1 has a surprising conformational stability and may act as a conformational linker and solubility enhancer within the scaffolding protein. The fold of X2 1 is very similar to that of telokin, titin Ig domain, hemolin D2 domain, twitchin immunoglobulin domain and the first four domains of the IgSF portion of transmembrane cell adhesion molecule. As a consequence, the X2 1 module is the first prokaryotic member assigned to the I set of the immunoglobulin superfamily even though no sequence similarity with any member of this superfamily could be detected.

Disulfide bridge reorganization induced by proline mutations in maurotoxin.

Maurotoxin (MTX) is a 34-residue toxin that has been isolated from the venom of the chactidae scorpion Scorpio maurus palmatus, and characterized. Together with Pi1 and HsTx1, MTX belongs to a family of short-chain four-disulfide-bridged scorpion toxins acting on potassium channels. However, contrary to other members of this family, MTX exhibits an uncommon disulfide bridge organization of the type C1-C5, C2-C6, C3-C4 and C7-C8, versus C1-C5, C2-C6, C3-C7 and C4-C8 for both Pi1 and HsTx1. Here, we report that the substitution of MTX proline residues located at positions 12 and/or 20, adjacent to C3 (Cys(13)) and C4 (Cys(19)), results in conventional Pi1- and HsTx1-like arrangement of the half-cystine pairings. In this case, this novel disulfide bridge arrangement is without obvious incidence on the overall three-dimensional structure of the toxin. Pharmacological assays of this structural analog, [A(12),A(20)]MTX, reveal that the blocking activities on Shaker B and rat Kv1.2 channels remain potent whereas the peptide becomes inactive on rat Kv1.3. These data indicate, for the first time, that discrete point mutations in MTX can result in a marked reorganization of the half-cystine pairings, accompanied with a novel pharmacological profile for the analog.

Dermoid cyst of testis in five-year-old-child.

We report the case of a five-year-old child who had a hard painless left testis discovered on a routine physical examination. He underwent a left inguinal orchiectomy, and the pathology examination revealed a dermoid cyst of the testis. This is a rare tumor, considering the low incidence of testicular tumors in childhood. Histologic criteria and surgical management are also presented. We believe this report is the first well-documented case.

[Percutaneous nephrostomy in the treatment of pyonephrosis. A comparative study apropos of 36 cases]. / Apport de la néphrostomie percutanée dans le traitement de la pyonéphrose. Une étude comparative à propos de trente-six cas.

This study is a comparison of the treatments used in 36 patients suffering from pyonephrosis. The patients were subdivided in two groups: cases having undergone previous percutaneous drainage; and cases having undergone primary nephrectomy. These latter cases presented a high complication rate. We believe that preliminary drainage by percutaneous nephrostomy, constitutes the procedure of choice, when ever possible, to drain the kidney and prepare the patient for nephrectomy.

[Ureterocele complicated by lithiasis. A study of 4 cases]. / Les urétérocèles compliquées de lithiase. A propos de quatre cas.

The authors report a series of 4 cases of ureterocele complicated by renal stones and treated in the Urology Department of the CHU of Sousse. The diagnosis was radiological and treatment was surgical, consisting of removal of the stones, excision of the ureterocele and ureteroneocystostomy.

[Purulent retention in the upper urinary tract and pregnancy. Apropos of 3 cases]. / Rétention purulente dans la voie excrétrice supérieure et grossesse. A propos de trois cas.

The purulent retention of the upper urinary tract is fortunately a rare urologic complication for the pregnant women. It decompensates a congenital or acquired uropathy. It is an important urologic emergency in which the diagnosis of obstruction, and the drainage of urines must be of immediate necessity as important as antibiotherapy, to avoid pyonephrosis and the destruction of the kidney. Concerning 3 cases, treated in the stage of pyonephrosis in the department of urology in Susa, we emphasize a premature diagnosis, which can only be done through an ultrasonography, the only guarantee to preserve the kidney. When possible, percutaneous nephrostomy constitutes an excellent means of drainage, while expecting a final disappearance of the obstruction.

[Infection and rupture of a serous renal cyst]. / Infection et rupture du kyste séreux rénal.

The authors report two cases of acute infection of a renal cyst with rupture into the urinary tract. The diagnosis was made by excretory urograms and ultrasonography. Differentiating a ruptured cyst from congenital caliceal diverticulum may sometimes be difficult. Antimicrobial treatment can control the infection and exclusion of the cyst was obtained in one case. The mechanism responsible for infection and rupture of the cyst are discussed, as well as the management of such cases.

[Prostatic abscess. Apropos of 2 cases]. / L'abcès prostatique. A propos de deux cas.

Prostatic abscess in an acute inflammatory condition in which clinical diagnosis is not always easy. Ultrasound is of considerable help in diagnosis of this prostatic pathology. We report two cases. The first patient was treated by trans-rectal drainage. The second was treated with success by percutaneous drainage. The clinical, diagnostic and therapeutic aspects of this rare pathology are discussed.

[Renal lithiasis and urothelial tumor]. / Lithiase rénale et tumeur de l'urothélium.

We report the cases of 4 patients with renal pelvis tumor associated with renal calculi. Sonography was correlated with gross pathology in three cases. The pre operative diagnostic can be made by sonography. The carcinogenic role of the lithiasis and infection is quite possible.

[Bladder fibrosis caused by eosinophilic cystitis]. / Fibrose vésicale due à une cystite à éosinophiles.

A 70-years-old man with no history of allergy or genitourinary problems had bilateral hydronephrosis, a marked decrease in bladder capacity and severe eosinophilic infiltration with fibrosis of the bladder wall. A total cystoprostatectomy with ileal bladder replacement was performed. We reviewed the literature of eosinophilic cystitis for clinical presentation, diagnosis and therapeutic options.

[Extra-adrenal pheochromocytoma. Report of two cases]. / Le Phéochromocytome extra-surrénalien. A propos de deux cas.

Paraganglioma is rare neoplasm. The authors report two new cases. The first case was a 36 year-old woman who presented with post-micturitional episodes of hypertension. Radiologic and endoscopic investigations showed a left submucosal bladder neck tumor. A partial cystectomy was performed under neuroleptanalgesia. The postoperative course was uneventful is simple. The second case was a 61 year-old woman who presented with a non secreting para-aortic paraganglioma.

[Contusions to the pathologic kidney. A retrospective study, apropos of 34 cases]. / Les contusions sur rein pathologique. Etude rétrospective, à propos de 34 cas.

The authors report a retrospective study of 34 cases of blunt renal trauma affecting a pathological kidney out of a total of 156 cases of renal trauma. The patients were between the ages of 3 and 60 years, with a male predominance (sex-ratio: 2.4). The predominant cause of trauma was a household accident, in 15 cases (44%). The clinical features were dominated by haematuria and pain. The underlying renal disease was dominated by renal stones (15 cases, 44%) and ureteropelvic junction (UPJ) abnormality (10 cases, 29%). Twelve patients with benign trauma and minimal underlying renal disease were treated conservatively. Surgery was indicated in the remaining 22 patients, but only 20 were actually operated. Nephrectomy was performed in 9 patients and partial nephrectomy was performed in 3 patients. Treatment consisted of UPJ plasty in 2 cases, uretero-caliceal anastomosis in one case, stone surgery in 4 cases and suture of ruptured renal pelvis in one case. The postoperative course was marked by the development of a urinary fistula in 1 patient, cured by drainage and deterioration of hydronephrosis in one patient. Lastly, one patient died from Wilms' tumour. This disease therefore tends to have a fairly benign course, which nevertheless depends on the underlying renal disease.

[Kidney injuries in children. Apropos of 65 cases]. / Le traumatisme du rein chez l'enfant. A propos de 65 cas.

The authors report a retrospective series of 65 cases of renal contusion in children affecting 45 boys and 20 girls between the ages of 10 months and 15 years (mean age: 10 years). The causes of renal trauma were dominated by household accidents (53.8%) and road accidents (33.8%). Associated extrarenal lesions were observed in 21.5% of cases. 55.4% of the 65 contusions were considered to be benign, 27.7% of moderate severity and 16.9% were serious. The blunt trauma affected a pathological kidney in 19 cases. Exclusively medical treatment was recommended in 31 patients, while surgery was indicated in the other 34 patients. Apart from one death in a context of multiple trauma, few complications were observed in the group of operated patients and consisted of 4 cases of urinary fistula and 4 cases of infection, all of which resolved.

[Testicular microlithiasis]. / La microlithiase testiculaire.

Testicular microlithiasis is an uncommon condition in which calcified concretions fill the lamina of seminiferous tubules. It has a specific appearance on sonography with diffuse intra testicular echogenic foci without acoustic shadows. Testicular microlithiasis can be associated with various entities and frequently with primary testicular neoplasm. The authors report a new case of testicular microlithiasis diagnosed by sonography in a 14-year-old boy with epididymo-orchitis. Based on a review and discussion of the literature, the authors emphasize the importance of regular and protracted ultrasound follow-up and monitoring of serum tumour markers to allow early detection of primary testicular neoplasm.

[Rupture of the excretory urinary tract due to a lithiasis of the pelvic ureter]. / Rupture de la voie excrétrice urinaire sur lithiase de l'uretère pelvien.

A case of rupture of the urinary tract related to lithiasis of the pelvic ureter is reported. Outcome was favorable after percutaneous drainage of the urinoma and removal of the stone using a Dormia catheter. Clinical diagnosis was readily established on the patient's history and on ultrasound and intravenous urogram findings.