The economic impact of subclinical ketosis at the farm level: Tackling the challenge of over-estimation due to multiple interactions.

Subclinical ketosis (SCK) is a major metabolic disorder that affects dairy cows, and its lactational prevalence in Europe is estimated to be at 25%. Nonetheless, few data are available on the economics of SCK, although its management clearly must be improved. With this in mind, this study develops a double-step stochastic approach to evaluate the total cost of SCK to dairy farming. First, all the production and reproduction changes and all the health disorders associated with SCK were quantified using the meta-analysis from a previous study. Second, the total cost of SCK was determined with a stochastic model using distribution laws as input parameters. The mean total cost of SCK was estimated to be Є257 per calving cow with SCK (95% prediction interval (PI): Є72-442). The margin over feeding costs slightly influenced the results. When the parameters of the model are not modified to account for the conclusions from the meta-analysis and for the prevalence of health disorders in the population without SCK, the mean cost of SCK was overestimated by 68%, reaching Є434 per calving cow (95%PI: Є192-676). This result indicates that the total cost of complex health disorders is likely to be substantially overestimated when calculations use raw results from the literature or-even worse-punctual data. Excluding labour costs in the estimation reduced the SCK total cost by 12%, whereas excluding contributors with scarce data and imprecise calibrations (for lameness and udder health) reduced costs by another 18-20% (Є210, 95%PI=30-390). The proposed method accounted for uncertainty and variability in inputs by using distributions instead of point estimates. The mean value and associated prediction intervals (PIs) yielded good insight into the economic consequences of this complex disease and can be easily and practically used by decision makers in the field while simultaneously accounting for biological variability. Moreover, PIs can help prevent the blind use of economic results in the field when only the mean value is considered.

[Uretero-vesival rupture with vaginal fistula following pelvic fracture. Value of early diagnosis and emergency surgery]. / Rupture urétrovésicale avec fistule vaginale au cours d'une fracture du bassin. Intérêt du diagnostic précoce et du traitement chirurgical en urgence.

Traumatic fracture of the pelvis led to the rare combination of urethra and bladder rupture and fistulization into the vagina. This unusual lesion can go undiagnosed initially and must be properly identified during the emergency gynaecology and urology examination. Tissue damage involved nearly the entire length of the urethra including both the smooth and striated sphincters. Reconstructive surgery produced good anatomic and functional results.

[Syndrome of the pyelo-ureteral junction of the graft after kidney transplantation. Apropos of 2 cases]. / Syndrome de la jonction pyélo-urétérale du greffon après transplantation rénale. A propos de 2 cas.

We report 2 cases of decompensation of a pelviureteric obstruction in a transplanted kidney. In one case, the pyeloureteral obstruction was discovered intraoperatively during grafting (cadaver kidney) and was corrected at that time. In the other case, the obstruction was decompensated one month after grafting (kidney taken from a living donor with a very discrete bilateral junction syndrome) and required surgical treatment. The procedure used in both cases was a pyelopyelic anastomosis after nephrectomy of the recipient's kidney.

[DNA content in 51 deparaffinized pT1 urothelial tumors. A follow-up of more than 6 years. Clinical evaluation, correlation with survival]. / Etude du contenu en ADN de 51 tumeurs urothéliales pT1 déparaffinées, avec plus de 6 ans de recul. Evaluation clinique, corrélation avec la survie.

We present 51 paraffin embedded pT1 bladder cancer ADN content measured by flowcytometry. We found good correlation between initial tumor ploidy and survival of patients. This ADN content appears more discriminative than histological parameters to predict survival.

[Evaluation of the results of the treatment of male urethral stricture with a follow-up of more than 5 years]. / Essai d'appréciation des résultats des traitements des rétrécissements de l'urètre masculin avec un recul supérieur à cinq ans.

149 cases of urethral stricture were treated in the Urology Department from 1971 to 1984. All of these patients have therefore been treated with a minimal follow-up of 5 years. There were 87 cases of post-traumatic stricture, 53 of whom were lost to follow-up during the survey, 8 died and 26 patients were able to be reviewed. The remaining 62 cases consisted of post-infectious strictures, with 37 patients lost to follow-up during the survey, 1 patient who died and 24 patients who were reviewed. The patients reviewed were assessed according to the criteria of the SFU (French Urology Society) survey. Direct vision internal urethrotomy was performed in 33 cases with 18 very good or good results (54%), segmental resection was performed in 10 cases with 7 very good or good results, urethroplasty was performed in 4 cases with 2 good results and 2 urethral dilatations were performed with 2 good results. The failures were essentially treated by more complex surgery (urethroplasty).

[Can the hormone-resistance of cancer of the prostate be predicted from the initial biopsy?]. / Peut-on prévoir l'hormono-résistance d'un cancer de prostate à partir de la biopsie initiale?

We present 271 prostatic adenocarcinomas with a follow-up of between 11.5 and 18 years, treated by palliative hormone therapy. Multivariate analysis defines three groups. Group 1 (78 cases): with a normal survival; Groups II and III: with poor survival. In this group, treatment is ineffective.