Bilateral ectopic pelvic kidney associated to left ureteropelvic junction syndrome: A case report.

Bilateral ectopic pelvic kidney is an exceptional finding and it may be associated rarely with other abnormalities of the kidney such as uretero-pelvic junction syndrome. We report a case of bilateral ectopic pelvic kidney revealed by left flanc pain with a left uretero-pelvic junction syndrome and a right ureteral duplication proved by computed tomography. A MAG3 renal scintigraphy was performed confirming the obstructive uretero-pelvic junction. An open left Anderson-Hynes pyeloplasty was performed without objectifying, preoperatively, any extrinsic compression without any postoperative complication. This case emphasizes on the possibility of the reconstructive management in such cases.

Primary hydatid cyst of the kidney revealed by hydatiduria: A case report.

Hydatid disease is frequent in endemic regions especially in sheep farming areas. Kidneys are uncommonly affected (2%-4%). We report a case of right renal colic with hydatiduria revealing a primary renal hydatid cyst ruptured in the mid calyx proved by computed tomography scan and laboratory testing. A kidney sparing surgery was performed by excision of the protruding dome and suturing of the fistula without any postoperative complication. This case emphasizes on further studies to define a standard treatment modality for renal hydatidoses.

Are Diabetic Patients at Increased Risk for Biochemical Recurrence After Radical Prostatectomy?

Introduction Diabetic patients are at a lower risk for prostate cancer. However, the relationship between diabetes mellitus (DM) and biochemical recurrence (BCR) after radical prostatectomy (RP) is less clear. The goal of our study was to determine diabetes's value as a biochemical recurrence predictor. Materials and methods We conducted a retrospective analysis of 117 patients who had undergone open radical prostatectomy between 1999 and 2021 at our institution. Univariate and multivariate statistical analyses were used to identify factors associated with biochemical recurrence. Results On univariate analysis, factors associated with biochemical recurrence were diabetes (p=0.002), preoperative prostate-specific antigen (PSA) levels (p=0.022), positive digital rectal exam (p=0.035), number of positive biopsy cores (p<0.001), unfavorable intermediate risk group (p=0.014), peri-neural invasion (PNI) on RP specimen (p=0.043), tumor volume (p=0.011), and positive surgical margins (p<0.001). Multivariate analysis showed that factors independently associated with biochemical recurrence were diabetes (p=0.039; OR=2.788), number of positive cores (p=0.016; OR=4.124), and positive surgical margins (p=0.008; OR=3.876). Conclusion A history of diabetes mellitus should be taken into consideration when assessing patients' risk of biochemical recurrence after radical prostatectomy. More research on a larger scale is needed to determine diabetes' value as a biochemical predictor.

[Renal epithelioid angiomyolipoma mimicking renal carcinoma]. / Angiomyolipome épithélioïde rénal mimant un carcinome rénal.

Epithelioid angiomyolipoma is a rare form of potentially malignant angiomyolipoma, recently considered separate entity by the World Health Organization classification of renal tumors. This lesion poses a problem in differential diagnosis with clear cell carcinomas. There are no clinical or radiological specific criteria that characterize this tumor. Immunohistochemistry revealing epithelioid cells with positive HMB45 marker is essential for diagnosis. Treatment should be discussed during the multidisciplinary consultation.

[Oncological and functional results of 50 consecutive radical prostatectomies]. / Résultats carcinologiques et fonctionnels de 50 prostatectomies radicales consécutives.

AIM: To evaluate the Oncological and functional results and to clear risk factors of biochemical recurrence in patients with prostate cancer treated by retropubic prostatectomy. METHODS: Retrospective analysis of 50 consecutive retropubic radical prostatectomies performed between January 1999 and january 2008. Biochemical recurrence was defined by PSA > 0.2 ng/ml. Univariate analysis of prognostic factors of biochemical recurrence was performed. The study of the urinary continence and the sexuality is essentially based on a meticulous interrogatory. RESULTS: The biochemical recurrence-free survival was 68%. Significant risk factors on univariate analysis were: number of positive biopsy, the percentage of positive biopsy, perineural invasion, Gleason score, clinical stage, pathological stage, and tumour volume. On the functional plan, only one patient is totally incontinent. The return to a normal sexuality appears uncertain, the sexual potency was satisfactory among 5 patients (10% of the patients operated and 55,5% of the patients having had a nervesparing techniques) CONCLUSION: Our oncological results is acceptable and are quite comparable to literature. This while guaranteeing the satisfactory functional results essentially basing on an acquirement of a continence quasi-perfect.

[Neuroacanthocytosis: a diagnosis that should be considered]. / Neuroacantheocytoses: un diagnostic à ne pas méconnaître.

BACKGROUND: Neuroacanthocythosis regroup heterogeneous neurodegenerative diseases. These conditions share neurological, hematological and even systemic features. In spite of the genetic progress, their pathogenesis is still unknown. AIM: To report a new case of neuroacanthocythosis CASE REPORT: A 37-year-old woman was admitted for orofacial choreatic movement disorder. These movements were associated to dysarthria, lip and tongue mutilation, areflexia and raised plasma creatine kinase level. Examination of blood smear reveled 10% of acanthocytosis. Neuro-acanthocytosis diagnosis, precisely choreaacanthocytosis, was done. CONCLUSION: Neuro-acanthocytosis should be considered in any movement disorder in order to attempt a genetic counseling.

The 20-core prostate biopsy as an initial strategy: impact on the detection of prostatic cancer.

INTRODUCTION: To increase the detection rate of prostate cancer in recent years, we examined the increase in the number of cores taken at initial prostate biopsy. We hypothesized that an increasing number of cores may undermine the accuracy of models predicting the presence of prostate cancer at initial biopsy in patients submitted to 20-core initial biopsy. METHODS: A total of 232 consecutive patients with prostate-specific antigen (PSA) between 4 and 20 ng/mL and/or abnormal digital rectal examination (DRE) underwent 12-core prostate biopsy protocol (group 1) or 20-core prostate biopsy protocol (group 2). The patients were divided into subgroups according to the results of their serum PSA and prostate volume. We evaluated the cancer detection rate overall and in each subgroup. Clinical data were analyzed using chi-square analysis and the unpaired t-test or 1-way ANOVA with significance considered at 0.05. RESULTS: The 2 groups of patients were not significantly different with regard to parameters (age, abnormal DRE and serum PSA), although median prostate volume in group 1 (57.76 +/- 26.94 cc) were slighter greater than in group 2. Cancer detection rate for patients submitted to 20 prostate biopsy was higher than patients submitted to 12 prostate biopsy (35.2% vs. 25%, p = 0.095). Breakdown to PSA level showed a benefit to 20 prostate biopsy for PSA <6 ng/mL (37.1% vs. 12.9%, p = 0.005). Stratifying results by prostate volume, we found that the improvement of cancer detection rate with 20 prostate biopsy was significant in patients with a prostate volume greater than 60 cc (55% in 20 prostate biopsy vs. 11.3% p < 0.05). Morbidity rates were identical in groups 1 and 2 with no statistically significant difference. There appeared to be no greater risk of infection and bleeding with 20 prostate biopsy protocol. CONCLUSION: The 20-core biopsy protocol was more efficient than the 12-core biopsy protocol, especially in patients with prostate specific antigen <6 ng/mL and prostate volume greater than 60 cc.

[Renal involvement in Fabry disease]. / Atteinte renale au cours de la maladie de Fabry.

BACKGROUND: Fabry disease is an X-linked recessive lysosomial storage disorder that is caused by deficient activity of alpha galactosidase A. Renal involvement occurs generally in hemizygous forms. AIM: We report one case of renal involvement in Fabry disease. CASE REPORT: A 47 year-old-man had focal and segmental glomerulosclerosis with moderate renal failure. As the patient presented history of acroparesthesias, hearing loss, left ventricular hypertrophy with arrhythmia and corneal deposits, hemizygous Fabry disease was suspected. This diagnosis was confirmed with low alpha galactosidase activity. After a follow up of 5 years, the renal function remains stable but the patient died by cardiac arrhythmia. CONCLUSION: Occurrence of a glomerulonephritis associated with an hypertrophic cardiopathy without hypertension should advocate Fabry disease.

Recurrent obstructions after resonance stent placement in the treatment of ureteral compression from malignant disease.

BACKGROUND: The Resonance ureteral stent is a newly developed all-metallic double-pigtail ureteral stent allowing a palliative diversion on a patient with malignant ureteral obstruction. AIM: To define selection criteria of good candidates for Resonance stent. CASE: A 62-year-old woman was admitted to the emergency department with complaining of severe right flank pain and anuria. Twelve days earlier, we had placed retrogradely a ureteral metallic Resonance stent (Resonance; Cook Ireland Ltd,Limerick, Ireland) for the treatment of a ureteral compression from pelvic recurrence of an appendical colloid mucosal carcinoma in a solitary functioning right kidney. A percutaneous nephrostomy catheter was placed, and an antegrade nephrostogram demonstrated complete distal ureter obstruction. The patency of the ureteral stent was restored spontaneously and then, nephrostomy catheter was removed. Two weeks later, she presented with obstructed ureteral stent. Percutaneous nephrostomy was performed and Resonance stent was removed definitively. Ureteroscopy with biopsy confirmed the tumour extension into the ureteral lumen. CONCLUSION: The risk of subsequent obstruction after Resonance metallic ureteral stent placement is real. Patients with intra-ureteral tumour extension are presumably not good candidates for Resonance stent management.

[Acute pancreatitis associated with hemophagocytic syndrome in systemic lupus erythematous: a case report]. / Pancréatite aiguë et syndrome hémophagocytaire au cours d'une poussée lupique: a propos d'une observation.

Exceptionally, acute pancreatitis and reactive hemophagocytic syndrome (RHS) are observed in the course of systemic lupus erythematosus (SLE). However, the association of the two conditions has never been reported before. A 31-years-old woman with a 7-year history of SLE was admitted for abdominal pain and fever. Elevated serum amylase and pancreatic enlargement on computerized tomography confirmed the diagnosis of pancreatitis. Laboratory examinations revealed pancytopenia, abnormal hepatic tests, and elevation of serum LDH and triglyceride levels. Bone marrow aspiration showed hemophagocytosis. The patient responded well to high dose corticosteroids. About eighty cases of pancreatitis have been reported in patients with SLE. The mechanisms are still unclear: SLE as the primary etiologic factor, drug toxicity, especially steroids which play a controversial role, or infection. About 40 cases of RHS have been reported in patients with SLE, sometimes associated with active infection. Overall mortality is 38.5%. When RHS occurs as an initial manifestation of SLE, or in the course of active SLE, it responds well to immunosuppressive therapy.

[Bilateral primary non-Hodgkin's lymphomas of the adrenals]. / Lymphome malin non-hodgkinien primitif bilatéral des surrénales.

Bilateral primary non-Hodgkin's lymphomas of the adrenals are rare: only 32 cases have been reported to date in the literature. We report a new case and recall the contribution of radiography to diagnosis.

[Wolfram syndrome. A new case report]. / Le syndrome de Wolfram. A propos d'une nouvelle observation.

The WOLFRAM syndrome (SW) is a rare hereditary disorder described for the first time in 1938 as the coexistence of a diabetes mellitus and an optic atrophy to which join frequently a diabetes insipidus and a bilateral deafness. Several genetic studies are current to determine transmission mechanisms, physiopathology of the disorder to update a curative therapy. On the occasion of a new case report we remind the main characteristics of this syndrome. The SW is a rare neurodegenerative disorder characterized by the coexistence of diabetes mellitus, diabetes insipidus, optic atrophy and deafness. Several other manifestations are frequently associated: neurological, urologic and endocrinous abnormalities as well as growth troubles. Only diabetes mellitus and optic atrophy are compulsory for the diagnosis. This Syndrome is transmitted to the autosomic recessive mode. Mitochondrial heredity is in the course of study. The systematic practice of a cerebral IRM during a SW allows finding several malformative abnormalities of which the most typical is the agenesis of the post-pituitary gland. The prognosis of the affection is essentially conditioned by the evoluting complications of the uropathy and the diabetes mellitus. The treatment is symptomatic. Genetic therapy is in.