[The French preliminary experience of the use of a seed-projector for exclusive iodine 125 prostate brachytherapy: feasibility and acute toxicity]. / L'expérience française de l'utilisation d'un projecteur de source pour la curiethérapie prostatique exclusive par implants permanents d'iode radioactif: faisabilité et données de toxicité aiguë.

PURPOSE: To analyse a new technique for prostate brachytherapy with permanent Iodine implants characterized by the use of a seed projector after a 3D dosimetric peroperative treatment planning (FIRST technique). PATIENTS AND METHOD: 395 patients have been treated in France with this technique in six radiotherapy centres between November 2002 and December 2005 for a localized prostate cancer. RESULTS: Thirteen patients (3.3%) developped a urinary retention, and respectively 7.8 and 26.5% an acute RTOG grade 3 and 2 toxicity. The 6-weeks IPSS score was equal or lower to 15 in 73% with a 11 median IPSS value. A failure of the loading with the seed-projector, leading to a manual loading of the seeds, occurred in 9 patients (2.3%) in two centres, directly related to the loading procedure with the seed-projector in 5 cases. The median duration of the procedure was reduced by 30 minutes for the patients treated in 2005. CONCLUSIONS: This multicenter study establishes the feasibility of the routine use of a seed projector for permanent iodine 125 prostate implants with an initial tolerance similar to the best results published for other implants techniques.

[Lymphoma with bladder involvement and renal transplantation]. / Lymphome à forme vésicale et transplantation rénale.

Based on the case of a renal transplant recipient who developed a monoclonal B cell lymphoma with plasma cell differentiation, arising in the bladder, the authors discuss the responsibility of intensive immunosuppressant protocols in the development of post-transplantation lymphoproliferative syndromes. The Epstein-Barr virus favours the development of these lymphomas. The bladder is a rare site. Diagnosis was based on endoscopic resection with immunohistochemical analysis. The prognosis depends on the stage at the time of diagnosis. At an early stage, resection of the tumour combined with reduction of immunosuppressant therapy may be sufficient, but more aggressive treatment is required for more advanced stages. Anti-B lymphocyte monoclonal antibodies (CD21, CD24) give good results, especially in polyclonal forms and Epstein-Barr virus primo-infections. Anti-CD38 monoclonal antibodies are currently being investigated and appear to be very promising. Conventional radiotherapy and chemotherapy are disappointing.

[Treatment of intradiverticular lithiasis by percutaneous methods (19 caliceal diverticuli)]. / Traitement de la lithiase intradiverticulaire par abord percutané (à propos de 19 diverticules calciels).

The main technical procedures in percutaneous nephrolithotomy are the direct puncture of the diverticulum (precise puncture may be required to place the tract directly on to the stone), and treatment duration the diverticulum could be coagulated and a large nephrostomy catheter could be left in place two days. No complication was encountered. One patient refused the treatment after unsuccessful puncture. The nephrostomy tube was left open for two days of drainage. Mean hospital stay was 5 days. Three patients required E.S.W.L because of persistent symptoms. One month after treatment 13 of 18 patients intravenous urography showed obliteration of the diverticulum (72%); Three months after 84% (15/18) of our patients were stone free and 94% (17/18) symptom free. Percutaneous nephrolithotomy should be performed for symptomatic patients, it has low complication rate and should be reserved for patients with persistent symptoms after E.S.W.L.

Endoscopic treatment of vesicoureteric reflux in transplanted kidneys.

Twenty-one patients underwent endoscopic subureteric injection of Polytef paste for the correction of secondary vesicoureteric reflux (VUR) in transplanted kidneys. Ureteroneocystotomy was performed in renal transplants using an extravesical technique in 19 patients and the Leadbetter-Politano technique in 2 cases. Success was achieved in only 6 patients, including the 2 ureters reimplanted according to the Leadbetter-Politano technique. No significant complication relating to the technique was observed. Despite the low success rate (30%), endoscopic treatment of VUR in transplanted kidneys is justified as a first attempt in view of the morbidity of VUR and the difficulties of repeated surgical reimplantation in this population.

[The significance of the use of fibrin glue in complete cystectomy with urinary diversion]. / Intérêt de l'utilisation de la colle de fibrine dans la cystectomie totale avec dérivation urinaire.

Two groups of 15 patients were submitted to radical cystoprostatectomy with urinary diversion. Was used in one group. Fibrin glue appears to be a valuable progress to improve the immediate follow-up of these patients, in terms of morbidity and the duration of parenteral assistance.

[Management of a pregnant woman with Streptococcus group B]. / Conduite à tenir chez une femme enceinte portant un streptocoque du groupe B.

The relative rarity (1 to 5 cases for 1,000 births) of neonatal infections secondary to B Streptococcus, the epidemiological characteristics of this germ, especially the unstable vaginal carriage, make it difficult to select a therapeutic approach. Systematic screening of B Streptococcus and the treatment of all carriers or only of high-risk patients, present several practical problems, are complex to implement but the cost/benefit ratio seems however acceptable. Prophylactic intrapartum antibiotic treatment of known carriers of B Streptococcus does not seem debatable any longer, at least the treatment of those presenting other risk factors: premature delivery, premature rupture of the membranes, fever occurring during delivery. Today, the best prophylaxis of neonatal infections seems to be the intrapartum antibiotic treatment (ampicillin) resulting in a spectacular decrease of the frequency of neonatal contamination.

[Ovarian cysts: ultrasound-guided puncture, celioscopy or laparotomy?]. / Kystes de l'ovaire: ponction échoguidée, coelioscopie ou laparotomie?

The authors report a series of 262 "ovarian tumors" operated on between 1982 and 1986. The place of "primary" laparoscopy went from 79% in 82-84 to 83% in 85 and 85% in 86 and the place of "pure" laparoscopic treatment went from 39% to 57% and 60%, respectively, excluding patients with an obvious cancer, patients over 40 and pregnant women over 16 weeks, in whom a primary laparotomy is indicated. The indications of the laparoscopic treatment may be carried further. And there is a place for a tap under ultrasonographic control. Various approaches are presented.