[The urological complications of pelvic fractures: about 22 cases at the University Hospital, Brazzaville]. / Les complications urologiques des fractures de la ceinture pelvienne : à propos de 22 cas au CHU de Brazzaville.

OBJECTIVE: To analyze the epidemiology, injury mechanisms and therapeutic aspects of urological complications of fractures of the pelvic girdle. PATIENTS AND METHODS: Retrospective study including 22 cases of urological complications of pelvic fractures analyzed between 2003 and 2010 at the University hospital, Brazzaville. Tile classification modified AO was used to understand the mechanisms underlying urological complications. The variables studied were: frequency, age, sex, origin, etiology, type of pelvic fracture, type of urological complications, clinical urological lesions, the therapeutic delay, the therapeutic method, the long-term prognosis. RESULTS: In total, 22 cases (11.40%) of urological complications were collected on 193 pelvic fractures. Men dominated the series with a sex ratio of 4.5, the average age was 33.8 years (12 to 64). Street accidents were the leading cause with 13 cases (59.09%). The urethra was the most affected in 16 cases (72.73%), the membranous portion in 10 cases (45.45%), the bladder in six cases (27.27%). Type A fractures were complicated four bladder lesions, types B, 12 urological lesions (1 bladder and urethra 11) and six type C lesions (1 bladder and urethra 5). Bone lesions were supported functionally in 18 cases (81.82%). Urethral injuries in men were repaired remotely by anastomotic urethroplasty. Urethral injury in females has been repaired urgently delayed. The bladder lesions were repaired by emergency laparotomy and suture of the breach, or urethral catheterization. In monitoring, seven patients had urological sequelae: erectile dysfunction in one case and urethral stenosis in six cases, they have been treated by dilatation (4 cases) and endoscopic internal urethrotomy (2 cases). CONCLUSION: The urological complications of pelvic fractures were rare in our experience, and must be systematically searched. Unstable fractures (types B and C) were the major providers of these complications. Remote processing was possible with good functional results.

[Urological complications of gynecologic surgery]. / Les complications urologiques de la chirurgie gynécologique.

OBJECTIVE: To analyze the epidemiological, anatomoclinical, surgical and evolutionary aspects of the urological complications of gynecological surgery. MATERIAL AND METHODS: It was about a retrospective survey, concerning 81 patients hospitalized in the department of urology of the university hospital, Brazzaville from 2000 to 2008 for urological complications of the gynecological surgery. The epidemiological, diagnostic, surgical and evolutionary parameters have been analyzed. RESULTS: The urological complication of the gynecological surgery has been recovered in 3% of patients hospitalized in urology. The middle age was 37±14.52 years (17 and 74 years). The median was about 36 years. The middle delay of diagnosis was 15 days (0 and 350 days). The revealing clinical signs were: the oligoanuria (n=12), the urinary incontinence (n=57), the lumbar pain (n=9) and the cyclic hematuria (n=2). The surgical interventions in reason were: the Caesarean (n=50), the hysterectomy for fibroma (n=26), the myomectomy (n=3) and the hysterectomy for cancer (n=2). Anatomical lesion were 55 (67.9%) vesicovaginal fistulas, 12 (14.8%) ureteral ligatures, eight (10%) uretero-vaginal fistulas, three (3.7%) vesico-uterine fistulas, two (2.4%) wounds ureteral and one (1.2%) vaginal vesico-fistulas and uretero-vaginal fistulas. The treatment consisted in one termino-terminal ureterorraphia, 20 uretero-vesical reimplantation, 57 cures of vesico-vaginal fistulas and one nephrectomy. The recovery was obtained at 96% of the ureteral lesions and 90% of the vesico-vaginal fistulas. CONCLUSION: The lesions of the ureteral and the bladder were often met during the gynecological surgery. The treatment requires knowledge of the anatomy of pelvis.

Les traumatismes des bourses

Objectif: Evaluer les caracteristiques epidemiologiques; cliniques; paracliniques et therapeutiques des traumatismes des bourses dans le service d'urologie - andrologie du CHU de Brazzaville Patients et methodes: Etude retrospective portant sur 18 patients hospitalises pour un traumatisme des bourses entre janvier 1990 et decembre 2006. Les parametres analyses ont ete: la frequence; l'age; les etiologies; le motif et delai de consultation; les resultats de l'examen clinique; les donnees echographiques; le protocole de traitement adopte et l'evolution. Resultats: Les traumatismes des bourses representaient 0;4des hospitalisations au CHU de Brazzaville. L'age moyen des patients etait de 34;6 ans (extremes 9 et 64 ans). Les traumatismes par accident de la voie publique (8 cas) et ceux du travail (5 cas) etaient les principales causes. Le delai moyen de consultation etait de 3 jours pour les traumatismes fermes (12 cas) et une heure pour les traumatismes ouverts (6 cas). Le principal motif de consultation etait la douleur scrotale (n=10). L'echographie realisee chez 8 patients a mis en evidence: 4 cas de rupture de l'albuginee; 2 cas d'hematomes intra testiculaires et 2 cas d'hematocele. Le traitement a ete medical dans 6 et chirurgical dans 12 cas. Les interventions ont consiste en la resection de la pulpe exteriorisee et suture de l'albuginee (n=4); une orchidopexie (n=1); une orchidectomie (n=3); une evacuation d'un hematocele (n=2) et un drainage d'un hematome testiculaire (n=2). A long terme; des douleurs testiculaires residuelles ont ete observees chez 3 patients; une ligoasthenozoospermie chez 3 patients; une atrophie testiculaire chez 2 patients et un cas de dysfonction erectile. Conclusion: Une exploration chirurgicale doit etre realisee en cas d'hematocele. L'echographie; entre des mains entrainees; peut faire le diagnostic de rupture de l'albuginee testiculaire cependantcet examen ne doit pas retarder la prise en charge au bloc operatoire

Ethylene Biosynthesis and Accumulation under Drained and Submerged Conditions (A Comparative Study of Two Rumex Species).

A model is presented of the regulation of ethylene biosynthesis in relation to submergence and flooding resistance. It is based on time-course measurements of ethylene production, ethylene accumulation, and concentrations of free and conjugated 1-aminocyclo-propane-1-carboxylic acid (ACC) in submerged and drained flooding-resistant Rumex palustris Sm. and flooding-sensitive Rumex acetosella L. plants. From these data, in vivo reaction rates of the final steps in the ethylene biosynthetic pathway were calculated. According to our model, submergence stimulates ACC formation and inhibits conversion of ACC to ethylene in both Rumex species, and as a result, ACC accumulates. This may explain the stimulated ACC conjugation observed in submerged plants. Although submergence inhibited ethylene production, physical entrapment increased endogenous ethylene concentrations in both flooding-resistant R. palustris and flooding-sensitive R. acetosella plants. However, R. palustris plants controlled their internal ethylene levels in the long term by a negative regulation of ACC synthase induced by ethylene. In flooding-sensitive R. acetosella plants, absence of negative regulation increased internal ethylene levels to more than 20 [mu]L L-1 after 6 d of submergence. This may accelerate the process of senescence and contribute to their low level of flooding resistance.

Submergence-Induced Ethylene Synthesis, Entrapment, and Growth in Two Plant Species with Contrasting Flooding Resistances.

Submergence-induced ethylene synthesis and entrapment were studied in two contrasting Rumex species, one flood-resistant (Rumex palustris) and the other flood-sensitive (Rumex acetosa). The application of a photoacoustic method to determine internal ethylene concentrations in submerged plants is discussed. A comparison with an older technique (vacuum extraction) is described. For the first time ethylene production before, during, and after submergence and the endogenous concentration during submergence were continuously measured on a single intact plant without physical perturbation. Both Rumex species were characterized by enhanced ethylene concentrations in the shoot after 24 h of submergence. This was not related to enhanced synthesis but to continued production and physical entrapment. In R. palustris, high endogenous ethylene levels correlated with enhanced petiole and lamina elongation. No dramatic change in leaf growth rate was observed in submerged R. acetosa shoots. After desubmergence both species showed an increase in ethylene production, the response being more pronounced in R. palustris. This increase was linked to the enhanced postsubmergence growth rate of leaves of R. palustris. Due to the very rapid escape of ethylene out of desubmerged plants to the atmosphere (90% disappeared within 1 min), substantial underestimation of internal ethylene concentrations can be expected using more conventional vacuum extraction techniques.

Erythema multiforme associated with autoreactivity to 17 alpha-hydroxyprogesterone.

We report a case of a 23-year-old woman who was afflicted with disseminated skin erythema multiforme-like eruptions that started at the menarche, relapsed at the premenstrual periods, dramatically spread during two pregnancies and cleared after abortion; the skin lesions responded dramatically to thalidomide treatment. A high-affinity binding factor to 17 alpha-hydroxyprogesterone (17-OHP) was found in the serum of this patient. Her lymphocytes did not proliferate in vitro after exposure to exogenous 17-OHP but showed significant chromatin activation. There was a decreased expression of HLA antigens at the surface of the patient's blood lymphocytes. This is a unique well-documented case of erythema multiforme most possibly due to autoreactivity to 17-OHP; the precise mechanism(s) of this autoreactivity has not been established.

[An in-vitro system study of the immunomodulating activity of taktivin in atopic dermatitis]. / Izuchenie v sisteme in vitro immunomoduliruiushchei aktivnosti taktivina pri atopicheskom dermatite.

In vitro effect of tactivin on E-rosette forming capacity of peripheral blood T lymphocytes of atopic dermatitis patients permits more accurate diagnosis of immunodeficiency degree, evaluation of the relations between T-cell immunity affection and immunomodulation results. Individual sensitivity of ERF cells to tactivin in vitro may be utilized for selection of patients in need for immunocorrection and the latter substantiation.