[Genito-urinary tuberculosis inthe male, apropos of 22 cases]

An evaluation of the epidemiological, clinical, prognostic and therapeutic characteristics of male genito-urinary tuberculosis, complemented by review of the literature. We retrospectively studied 22 patients with confirmed genitor-urinary tuberculosis. The diagnosis was based on clinical, bacteriological, radiological and histological findings and radiological examination. The most common presenting symptom was chronic epididymitis [11 patients] followed by scrotal fistula [6 cases], obstructive uropathy [3 cases], hydrocele [6 cases] and infertility [1 case]. Clinical examination revealed epididymal nodules in 11 and hydrocele in 10 patients. Leucocyturia was found in one patient. Scrotal ultrasound demonstrated epididymal lesions in 8 cases. The definite diagnosis was based on histological examination of resected specimens [13 cases], biopsy specimens [8 cases] and on the discovery of the tubercle bacillus in the urine [1 case]. Intravenous urography, which was carried out routinely, detected associated urinary lesions in 5 cases. The follow-up was uneventful in all patients. The diagnosis of male isolated genitor-urinary tuberculosis is difficult in the absence of an endemic prevalence of tuberculosis. Any longstanding epididymo-orchitis should raise the suspicion of tuberculous etiology, especially in cases with hypofertility. Medical treatment has proven effective in early diagnosed cases, while surgery is reserved for resistant or complicated cases

[Treatment of iatrogenic ureteral injuries. A propos of 24 cases]

To evaluate the diagnosis and treatment of 24 patients with ureteral injury at our institution. In this retrospective study we evaluated 24 patients [22 females and 2 males] with ureteral injury treated at our institution between June 1993 and June 2005. The average age was 41 years [range 22-65 years]. the majority of ureteral injuries occurred during gynecological surgery [22/24 cases = 92%]. The time elapsed between the ureteral injury and diagnosis was 5 months on average; only in one case [3.8%], the injury was discovered during surgery. Four patients were treated endoscopically while ureteroscopy and end-to-end anastomosis was applied in 5 and open surgery in 15 cases. End-to-end ureterorraphy with placement of a double-J catheter was necessary in one patient, where endoscopic treatment had failed. After an average follow-up period on 60 months, loin pain had resolved in all cases. On radiological evaluation, a residual uretero-pyelocalyceal hyptony was noted in 5 cases and a satisfactory ureteral passage without strictures in the others. No nephrectomy was necessary in this series. Ureteral injury is most often secondary to gynecological surgery. In the majority of cases endourologic repair is the treatment of choice. It is recommended to pass ureteral catheters pre-operatively in order to ease the repair of the injury

[Bilateral hemorrhagic renal angiomyolipoma. Case report and review of the literature]

Renal angiomyolipoma is a rare benign tumor representing 0.3% of renal tumors. In its bilateral from it is frequently part of a hereditary syndrome, such as tuberous sclerosis of Bourneville [TSB]. We report the case of a 32-year-old who has been followed up for TSB since 1995. In April 2004 she was hospitalized after several episodes of total hematuria with blood clots in the bladder causing severe exsanguination and the need for repeated blood transfusions. Serum creatinine was normal. Ultrasound and CT scan showed the presence of bilateral renal angiomyolipomas. The bleeding could be controlled by arterial embolization of the right kidney. One month later, the patient was admitted again with massive hematuria and hemorrhagic shock, and right nephrectomy was done to achieve hemostasis. The follow-up period of 24 months has been uneventful

Chrurgie des anevrismes de l'aorte acsendante

Evaluation of the short and middle term morbidity and mortality rate of ascending aortic aneurysm surgery. Material and methods: It is a retrospective study of 21 ascending aortic aneurysm patients operated between May 1996 and may 2003. The interventions were of Bentall's type in 11 cases [4-25], Carbrol's in 6 cases [6-28%] and Weath's type in 4 cases [19%]. A total of 21 patients-16 males and 5 females- average age of 45 years +/- 8-12 [15-68]. Four patients [19%] had acute complicated discecting aneurysm. Two patients [5-9%] had MARFAN'S syndrome. Sixteen patients [57 +/- 6,3%] had aortic regurge grade II to IV. Seventeen patients [81%] had NYHA'S functional class II-III. Average aneurysmal diameter was 57 mm +/- 6,3 [48-80mm]. Operative mortality rate was nil. Hospitalisation period was 19 +/- 4 days [16-40 days]. Three patients had complete atrioventricular heart block. Lately 2 patients died as a result of thromoembolic accidents. The ascending aortic aneurysm surgery can be achieved with immediate results similar to surgical aortic valve replacement. The mode of surgery and necessity of a long course of anticoagulant treatment affect the middle and long term prognosis

Remplacement valvulaire aortique associe au pontage cronaire

The progress achieved in the cardiac surgery and resuscitation fields allowed an enlargement of surgical indications to invalue inoperable patients. A typical example is the association of aortic valve stenosis with coronary stenosis in elder patients. The authors report a series of 6 male patients who underwent an aortic valve replacement associated with coronary artery bypass grafting [CABG] at the cardioc surgery department "B", between May 1996 and May 2003. The average age was 64,5 years [52-74]. All of them had a significant and symptomatic aortic valve stenosis. One patient had left ventricular dysfunction. All the patients had a stable hemodynamic status in the preoperative period. Five patients benefited from bioprosthesis valve, while the 6th patient had a mechanical one. The mean number of bypass was 2,1 per patient. The mean time of aortic cross clamp was 97min. Hospital mortality was nil. One patient developed acute renal insufficiency, while an other suffered from myocardial infarction and pulmonary infection. The aortic valvular replacement associated with CABG is a highly risk surgery. The operative indications that give best prognosis depend on the age factor [less than 70 years] and timing factor of surgery [suitable timing]