Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory.

INTRODUCTION: The AAST renal injury grading scale is currently the most important variable predicting the need for kidney repair or removal, morbidity and mortality after blunt or penetrating kidney injuries. The 2011 revised version included renal pelvis, uretero-pelvic junction and segmental vascular injuries as grade IV, limiting grade V to severe hilar injuries. However, patients requiring surgery cannot be properly identified because of hemodynamic instability due to grade IV renal injuries. This study proposes an add-on for the AAST grade IV renal injury scale to improve the management of these patients. METHOD: We searched the Medline and Scopus databases up to September 2014. Searches were not restricted by date, language or publication status. Pediatric studies were excluded. RESULTS: 71 articles were found, 57 were pertinent, including 6 directly related to the topic. 3 risk factors were identified to be associated with surgery for hemodynamic instability: perirenal hematoma >3.5 cm, intravascular contrast extravasation and medial renal laceration. Presence of two or more of these criteria has been validated in two other studies to predict the need for intervention. Patients with >25 % devascularized fragments also have poor prognosis and should be treated more aggressively. CONCLUSION: These elements should be included in future classification reassessment to efficiently determine the time for surgery in grade IV renal traumas, generally leading to nephrectomy.

[Epidemiology of urinary stones in the French military during the operation Serval]. / Épidémiologie de la lithiase urinaire chez les militaires français au cours de l'opération Serval.

OBJECTIVES: The renal colic crisis is a pathology frequently encountered in foreign operations recently conducted by the French army and often requires a medical repatriation in mainland France. Soldiers deployed in arid areas are at increased risk of developing urolithiasis. The purpose of our study is to analyze the risk factors, the frequency and the methods of management of symptomatic urinary stone disease for French military returnees for renal colic during Serval operation. METHODS: Our study focused on French soldiers repatriated from Mali for a renal colic care between January 11th and November 30th, 2013. For each patient, we recorded: age, sex, deployment date, crisis date, personal and family histories of urolithiasis, initial medical treatment, diagnosis and treatment to return to France. RESULTS: Three hundred and forty-eight soldiers were evacuated during Serval operation, among which 41 were due to the occurrence of renal colic crisis (11.7%). Twenty-nine percent of patients had a personal history of kidney stone disease symptomatically. The average residence time when the crisis appears is 60 days (10-120 days). Ninety-five percent of patients were asymptomatic at their arrival in France and 39% of patients had no stone found in CT scan. The average size of the stones found on the imaging was 2.71 mm (1-8mm). One patient required drainage by JJ ureteral endoprothese in order to have a quick ureteroscopy for recovery of its capacity. CONCLUSION: The French military sent to Serval operation are exposed to multiple contributing factors of urolithiasis as the dehydration and the strong temperature. The analysis of our series reveals that the history of renal stone disease is the main factor favoring and the medical treatment is effective in almost all renal colic cases. The operational impact associated with this common condition in the Sahel region deserves an awareness of field practitioners to the screening and management of this disease in a precarious situation and a reflection of the staffs concerning the access onto the operating theater to appropriate diagnostic and therapeutic means that could facilitate the return to the combat unit.

[Mediastinal localization of a growing teratoma syndrome: a case report]. / Localisation thoracique d'un growing teratoma syndrome : à propos d'un cas.

The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.

[Growing teratoma syndrome]. / Le growing teratoma syndrome.

Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.

Fever of unknown origin: Importance of 18F-FDG PET/CT in the diagnosis of a late infectious complication after aneurysm bypass.

Persistent blood flow in aneurysmal sac after bypass-exclusion is well documented in the literature. Aneurysm enlargement, local compressive symptoms and even sac rupture are commonly described complications. Late secondary infection of popliteal artery aneurysm (PAA) following ligation and venous bypass is exceptional. We report the case of late PAA infection six years after bypass-exclusion in a 75 year-old man which was diagnosed by 18F-FDG PET/CT. The patient was successfully treated by aneurysm resection and antibiotics. The diagnosis of popliteal aneurysm infection is often clinical, echographic and sonographic, but computed tomography scan can be false negative in chronic low-grade infection. 18F-FDG PET/CT is able to accurately diagnose and localize infection with high sensibility and specificity.

[Renal pseudotumoral actinomycosis: a case report]. / Actinomycose rénale d'aspect tumoral: à propos d'un cas.

We report the case of a 66-year-old man, presenting a right kidney mass with an alteration of the clinical status, treated by radical nephrectomy. Pathology reported that it was a pseudotumoral form of a bacterial infection: actinomycosis. This is an uncommon disease in this location. The authors wonder if it is possible to avoid nephrectomy with a preoperative diagnosis, especially with renal biopsy. The patient was well doing after 18 months thanks to long-lasting and effective postoperative antibiotics (Dhanani et al., 2004).