Evaluation of urolithiasis in Crohn's disease in Tunisian patients

To investigate the characteristics of urolithiasis associated with Crohn's disease [CD] in a sample of Tunisian population. We retrospectively studied 184 patients with CD to reveal any urolithiasis during evolution. Evidence for the presence of renal calculi was obtained from plain films, ultrasonography or intravenous urography and computed tomography. Renal calculi were found in only three patients with CD. All patients were woman. Mean time from diagnosis of CD to diagnosis of calculi was 22 months [range 6 to 48 months]. Clinical features were not specific. Calculi were bilateral in two cases. The rate of concurrent urolithiasis was very low in the present series of Tunisian patients. Although rare, efficient treatment and prevention of calculi formation are mandatory in CD patients'

Primary testicular non-Hodgkin lymphoma. A 10-year Tunisian single-institute experience

Primary testicular non-Hodgkin lymphoma [NHL] is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used. To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma. We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables. Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later. Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL

[Emphysematous pyelonephritis. Epidemiological, clinical, biological, bacteriological, radiological, therapeutic and prognostic features. Retrospective study of 30 cases]

Emphysematous pyelonephritis is an uncommon, necrotizing bacterial infection of the kidney. It is a severe, lifethreatening affection. To study the epidemiological, clinical, biological, bacteriological and radiological features of this affection, and to describe its therapeutic management and prognostic characteristics. We conducted a retrospective study including 30 patients who were treated for an emphysematous pyelonephritis, in Charles Nicolle hospital department of urology, from 1987 to 2009. Emphysematous pyelonephritis generally affects adults. It is especially favored by diabetes and urinary tract obstruction. Escherichia coli is the main causative agent. Uroscan is the key of diagnosis. It is both medical and surgical emergency; the treatment combines intensive care with appropriate antibiotics and often drainage. Nephrectomy may be necessary from the outset, or after drainage failure. Prognosis is poor, with a high mortality rate [23%], in our series. Management of emphysematous pyelonephritis poses real problems. This affection is still threatening, despite of advances in intensive care

[Is there a link between the occurrence of kidney cancer and hypertension in Tunisian population?]

Kidney cancer is generally asymptomatic and discovered incidentally at a late stage, which is a negative diagnosis because in most cases the disease is incurable at this stage. Some predisposing factors have been revealed by studies such high blood pressure, which is a frequent among the Tunisian population. A study among the Tunisian population to determine if there is a link between the occurrence of kidney cancer and the hypertension. Our work was conducted on 91 patients with confirmed renal cell carcinoma and 91 healthy subjects who consulted the Urology Department at the Charles Nicolle Hospital in Tunis. The study of clinical records has identified the clinical, pathological and therapeutic features of the 182 patients. 59% of individuals with hypertension have developed kidney cancer with a significant p-value equal to 0.03. The more the value of blood pressure increases the more the risk is [p = 0.03]. Smoking in combination with hypertension is a factor favoring the occurrence of cancer with a value of p equal to 0.05. In the Tunisian population hypertension is a risk factor for developing kidney cancer, a factor compounded by the high incidence of this disease. What prompts us to make explorations of kidney lodges of hypertensive patients

Vascular complications after pediatric kidney transplantation

Vascular complications, especially those including the renal vein, remain a major cause of lost graft. To evaluate retrospectively the incidence and management of vascular complications after pediatric renal transplantation and to assess possible risk factors and their effects on patient and graft. A total of 82 consecutive renal transplants were performed in 79 patients at a single institution. The diagnosis of vascular complications was suspected in the presence of suggestive symptoms and confirmed by Doppler ultrasound and if necessary by a computed tomographic angiography. Urgent exploration was performed in all suspected cases. There were seven vascular complications [8,5%], including renal vein thrombosis in four patients, renal artery stenosis in one, and sural thrombophlebitis in two. The thrombosis of the graft vein which is the main complication occurred at mean 24 hours after renal transplantation. All these patients needed transplant nephrectomy after thrombosis event. In the remaining cases, the outcome was favorable even for the patient with transplant renal artery stenosis. Vascular complications are common and serious events affecting patient and graft survivals. A perfect surgical technique and rigorous radiological monitoring may result in decreased incidence and severity of these complications

NY-ESO-1 expression and immunogenicity in prostate cancer patients

Prostate cancer is the second leading cause of men cancer-related death. Cancer immunotherapy has been investigated as a treatment which might be instituted at the point of detection of androgen-independent metastatic disease. To investigate the expression and humoral response against NYESO-1 in patients with prostate cancer [PC] and to analyze the relationship between expression of NY-ESO-1 and clinicopathological features. NY-ESO-1 mRNA in surgically resected PC and benign prostatic hyperplasia [BPH] were examined by reverse transcriptionpolymerase chain reaction. The antibody response to NY-ESO-1 was examined by enzyme-linked Elisa assay using recombinant NYESO-1 protein. NY-ESO-1 mRNA was detected in 9 of 23 [39%] PC patients. Antibodies against NY-ESO-1 protein were detected in 12 of 23 [52%] sera of PC patients and in 5 of 9 [55%] of NY-ESO-1 expressing tumors. However, no mRNA copy or NY-ESO-1 antibodies were detected in all BPH patients tested. The present study has demonstrated the expression of NY-ESO-1mRNA in prostate Cancer patients and NY-ESO-1 antibody production. Our data suggest that NY-ESO-1 could be used as a tumor marker and constitute a good candidate for vaccine-based immunotherapy for hormonal resistant prostate cancer patients

utility of alpha-methyl CoA racemase [P504S] expression as a marker of renal cell carcinomas

Renal cell tumours are numerous and heterogeneous. Because of their clinicopathological heterogeneity, their accurate diagnosis may be challenging. In case of an equivocal diagnosis, immunohistochemistry may be a useful mean of diagnosis. Recently, alpha-methyl CoA racemase has been identified as a useful marker in kidney cancers. Our objectives are to highlight the role of alpha-methyl CoA racemase [AMACR] as a diagnostic marker in papillary renal carcinoma and to assess its utility in the other tumour types. A retrospective review was performed on 62 patients who were treated for renal tumours between January 1994 and November 2005. Immunoreactivity was evaluated with a qualitative manner. Positive AMACR staining was defined as a coarse dense cytoplasmic granularity. The 62 renal tumours were diagnosed as papillary tumours in 22 cases, clear cell tumours in 18 cases, chromophobe carcinoma in 12 cases and oncocytoma in 10 cases among the 22 cases of papillary tumours, all the cases [100%] showed cytoplasmic immunoreactivity staining. 4 cases between the 18 clear cell carcinomas [22%] showed positivity with AMACR. The 12 cases of chromophobe carcinoma didn't express AMACR by immunohistochemistry. Only one case between the oncocytomas [1%] expressed AMACR. This study confirms the high sensitivity of AMACR for papillary renal cell carcinomas but we must keep in mind that weak focal AMACR staining could be present in other renal cell carcinomas

[Place of percutaneous nephrolithotomy in the treatment of staghorn stones. about 83 cases]

Staghorn stone is considered as a dreadful type of renal stones. The choice of the best treatment is always difficult. To evaluate the results of percutaneous nephrolithotomy in the treatment of staghorn stones. We report 83 cases of staghorn stones that were treated by percutaneous nephrolithotomy during a period of 10 years from 1994 to 2004. The mean age was 44 years and sex-ratio was 2.2. The right kidney was treated alone in 42% of cases, the left one in 56% of cases and both kidneys in only two cases. The mean area of stones was 6,6 cm[2]. One renal puncture was necessary in 97% of cases. The rate of stone free after percutaneous nephrolithotomy only was about 54% and when combined with lithotripsy the rate was 64%. Combined treatment using percutaneous nephrolithotomy and lithotripsy is considered as the best procedure for staghorn stones treatment

[Emphysematous pyelitis: epidemiological, therapeutic and evolutive features]

Emphsematous pyelitis is an uncommon form of acute pyelonephritis. It has been reported sporadically in the literature. Our objective is to study the epidemiological, clinical and therapeutic characteristics of emphysematous pyelitis. The-data-of six patients- managed-for emphysematous-pyelitis were collected and analyzed. The mean age was 55 years. Urinary lithiasis and diabetes were the most common co-morbidities. Febrile lumbar pain and general health impairment were the presenting symptoms in five patients; the remaining case presented with septic shock. Urine and blood culture grew E. Coli in 4 and 3 cases respectively. Computed tomography of the abdomen led to diagnosis by showing gas images in the collecting system. Treatment consisted of antibiotics associated with collecting system drainage. It avoided emergent nephrectomy in all cases. The treatment of the calculi was held at distance from the infection. Nephrectomy was done in one patient presenting a thinned - dedifferentiated - renal parenchyma. Outcome was good. Emphysematous pyelonephritis is a rare upper urinary tract infection. Risk factors include diabetes and urinary obstruction. The diagnosis is made by computed tomography. Efficient antibiotics administration associated with collecting system drainage allow soon recovery and avoid nephrectomy

[Multilocular cystic renal cell carcinoma]

Multilocular cystic renal cell carcinoma is an uncommon variant recently described of renal cell carcinoma. Analyze clinicopathological features, imaging findings and prognosis and therapeutic options of this tumor. The authors reported two cases of multilocular cystic renal cell carcinoma arising in 68 and 39 year old men. They were admitted with pain in the lumbar region and/or haematuria. The imaging findings were a renal neoplasm with cystic and solid areas. The pathologic findings confirm the diagnosis of multilocular cystic renal cell carcinoma. Multilocular cystic renal cell carcinoma, usually identified at earlier stages, had slower growth rate and was therefore associated with a better prognosis and longer survival than conventionnal renal cell carcinoma

[Seminal vesicle abscess: report of a new case]

Seminal vesicle abscess [SVA] is a rare pathologic entity, usually diagnosed by transrectal ultrasonography and computerized tomography scan. Report a new case. We report the successful management of a serminal vesicle abscess with percutaneous transvesical drainage in a 60 year old diabetic patient. Computed tomography scan has been used for the diagnosis and the guidance of the percutaneotz drainage. Seminal vesicle abscess is a very rare pathology with no specific symptoms. Transvesical drainage can be proposed successfully

[Vascular trombosis of renal graft: 9 cases]

Allograft renal thrombosis can occur in 1 to 6% of cases. Many predisposing factors has been identified especially alteration of coagulation. We analyzed in this study frequency and predisposing factors of renal graft thrombosis. We report a retrospective study including 319 renal transplant recipients. Nine patients [2, 8%] presented veinous graft thrombosis in 5 cases and arterial thombosis in 4 cases. There were 6 men and 3 women aged of 30, 6 years meanly [10-56] which developed the thrombosis 6 days [1-48] after the transplantation. All patients were detransplanted after 16, 2 days and 1 patient died. Thrombosis constitute an important cause of graft loss. A perfect surgical technic and prophylactic treatment in high risk patients are necessary to reduce this complication

[Lumboscopic treatment of ureteral stones. About 31 cases]

The aim of our study is to state the efficiency and the place of lumboscopy in the treatment of ureteral stones. We report 31 cases of patients operated by lumboscopy for ureteral stones from January 2001 to December 2005. In most of cases, the indication is stone which size is higher than 15 mm. The mean operating time is 91 min and the rate of conversion to open surgery is 9, 7%. 9 [29%] postoperative complication is noted. The mean hospital stay is 5 days. No ureteral stricture or kidney destruction is noted with a mean follow-up of 34 months. Lumboscopy is a safe and effective technique in the treatment of the ureteral stones with a low rate of complications. It can replace open surgery in most of cases