Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África / Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men

Antecedentes: Los hombres norteafricanos (NAF) presentan una alta incidencia de cáncer de próstata (CaP) avanzado en el momento del diagnóstico. Varios estudios han demostrado la existencia de diferencias étnicas en la agresividad del CaP y esto ha dado lugar a algunas preocupaciones relacionadas con la inclusión de algunos grupos étnicos en los protocolos de vigilancia activa. Objetivo: Evaluar los resultados patológicos y la agresividad del CaP de bajo riesgo tratado con prostatectomía radical en un grupo étnico NAF. Sujetos y métodos: Los datos de 147 NAF sometidos a prostatectomía radical por CaP de bajo riesgo diagnosticado por medio de una biopsia de 12 núcleos en 2 centros académicos entre 2011 y 2015 se revisaron retrospectivamente para evaluar las tasas de resultados patológicos peores definidas como: actualización de la puntuación de Gleason a por lo menos 3 + 4, eclipse a pT3a o superior o pN1, y márgenes quirúrgicos positivos. Resultados: El eclipse y/o actualización significativa global se produjo en el 20,2% y se produjeron márgenes quirúrgicos positivos en el 18,3%. En el análisis de regresión logística multivariante, las variables independientes que predijeron eclipse y/o actualización o márgenes quirúrgicos positivos en toda la cohorte fueron: grupo de riesgo NCCN (riesgo bajo > riesgo muy bajo), edad avanzada > 60 años, PSA > 6 ng/ml, densidad de PSA ≥ 0,15, más de 2 núcleos positivos en la biopsia, implicación del cáncer de más del 50% en los núcleos positivos, estadio clínico (T2a > T1c) y puntuación UCSF-CAPRA-S > 3. Conclusiones: Nuestro estudio encontró que, al menos patológicamente, los hombres NAF no tienen una enfermedad más agresiva que los caucásicos y afroamericanos, tanto en CaP de bajo como de muy bajo riesgo. Por lo tanto, creemos que la vigilancia activa es un enfoque adecuado para pacientes seleccionados ya que no hay datos definitivos que muestren una historia natural más agresiva de CaP en hombres NAF

Background: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. Objective: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. Subjects and methods: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3 + 4, upstage to pT3a or higher or pN1, and positive surgical margins. Results: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk > very low risk), advanced age > 60 years, PSA > 6 ng/ml, PSA density ≥ 0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a > T1c) and UCSF-CAPRA-S score > 3. Conclusions: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men

Pathological outcomes and agressiveness of low-risk prostate cancer in Northern African men. / Resultados patológicos y agresividad del cáncer de próstata de bajo riesgo en los hombres del norte de África.

BACKGROUND: Northern African (NAf) men show a high incidence of advanced prostate cancer (PCa) at diagnosis. Several studies suggested the existence of ethnic differences in the PCa aggressiveness and this has led to some concerns related to the inclusion of some ethnic groups into active surveillance protocols. OBJECTIVE: To evaluate pathological outcomes and aggressiveness of low risk PCa treated by radical prostatectomy in a NAf ethnic group. SUBJECTS AND METHODS: Data of 147 NAfs, who underwent radical prostatectomy for low risk PCa diagnosed via a 12-core biopsy in 2 academic centers between 2011 and 2015, were reviewed retrospectively to assess rates of worse pathological outcomes defined as: Gleason score upgrade to at least 3+4, upstage to pT3a or higher or pN1, and positive surgical margins. RESULTS: Overall significant upstage and/or upgrade occurred in 20.2% and positive surgical margins occured in18.3%. In multivariate logistic regression analysis, independent variables that predicted for upstage and/or upgrade or positive surgical margins in the entire cohort were: NCCN risk group (low risk>very low risk), advanced age>60 years, PSA>6ng/ml, PSA density≥0.15, more than 2 positive cores in biopsy, more than 50% cancer involvement in positive cores, clinical stage (T2a>T1c) and UCSF-CAPRA-S score>3. CONCLUSIONS: Our study found that, at least pathologically, NAf men do not have more aggressive disease than Caucasians and African Americans in both low and very low risk PCa. Thus, we think that active surveillance is a suitable approach for selected patients since there is no definitive data that show a more aggressive natural history of PCa in NAf men.

Percutaneous endoscopic nephropexy with a percutaneous suture passed through the kidney.

OBJECTIVES: To report a technique of percutaneous endoscopic nephropexy, using a polyglactin suture passed through the kidney, in patients with nephroptosis. PATIENTS AND METHODS: Four women presenting with symptomatic right nephroptosis underwent a percutaneous endoscopic nephropexy. An upper-pole calyx was accessed percutaneously and a 24-F working sheath was placed. Another needle access was made through a lower-pole calyx and a #2 polyglactin suture was passed into the renal pelvis. It was then pulled out through the upper-pole tract using the nephroscope. A retroperitoneoscopy was performed and the tip of the nephroscope was used to cause nephrolysis. After inserting the nephrostomy tube the polyglactin suture was passed into the subcutaneous tissue and then tied without too much tension, to avoid cutting the parenchyma. RESULTS: The operative duration was 33 min and the hospital stay after surgery was 3.5 days. The nephrostomy catheter was removed 5 days after surgery. There were no complications, especially no haemorrhagic, infectious, lithiasic or thoracic complications. The four patients were relieved of their initial symptoms, with a mean follow-up of 28 months. Ultrasonography and/or intravenous urography showed the kidney at a higher location with the patient standing. CONCLUSIONS: This technique combines the nephrostomy tract used in percutaneous techniques with the suture and nephrolysis used in laparoscopic techniques. Moreover, this procedure seems to be safe, with satisfactory anatomical and clinical results and a lower morbidity. However, a larger series will be necessary to establish its long-term morbidity and success rate.

[Macular edema revealing scleral necrosis following scleral buckling surgery]. / OEdème maculaire cystoïde révélateur d'une nécrose sclérale secondaire à une indentation sclérale.

INTRODUCTION: Macular edema is a very rare complication of scleral necrosis after scleral buckling surgery. OBSERVATION: We report the case of a 45-year-old women with an ocular history of severe myopia in both eyes and retinal detachment in the left eye. She underwent segmental scleral buckling in 2003. Two years and nine months later, the patient had acute, painless visual loss in her left eye. Funduscopic examination revealed cystoid macular edema with no intraocular inflammation. A fluorescein angiography and OCT revealing cystoid macular edema consistent with the macular edema was noted clinically. The surgical exploration revealed scleral necrosis beneath the scleral buckle. After removal of the scleral buckle, a scleral patch was performed. Several months after surgery, the vision had improved; funduscopic examination and OCT revealed no residual macular thickening. DISCUSSION: Macular edema is a rare complication of scleral necrosis following scleral buckling surgery, with only one case described in the literature. Our patient's complication occurred 2 years after surgery. The macular edema is likely the result of the scleritis. This inflammatory process can extend from the sclera and result in several ocular complications, including uveitis. Regression of macular edema occurs frequently after removal of the scleral buckle.

[Postoperative Candida Iris nodules: report of a case]. / Nodules iriens postopératoires à candida: à propos d'un cas.

PURPOSE: Description of an uncommon case of postoperative Candida iris nodules. CASE REPORT: A 70-year-old immunocompetent patient developed whitish iris nodules after phacoemulsification in the left eye, without any other signs of endophthalmitis. Histophathological examination showed spores of candida. These nodules did not respond to intracameral amphotericin B but disappeared with oral fluconazole. However, the functional outcome was poor because of persistant inflammation of the anterior segment. CONCLUSION: In the presence of postoperative iris nodules, fungal etiology must be considered.

[Langerhans cell histiocytosis located in the orbit]. / L'histiocytose Langerhansienne a localisation orbitaire.

Langerhan's cell Histiocytosis of the orbit. Langerhan's cell Histiocytosis is a rare condition that affects children and less frequently young adults. It is characterized by a proliferation of histiocytes derived from Langerhan's cells. Orbital involvement is described in 20% of cases where orbital eosinophilic granuloma located in the frontal bone is the most frequent. The malignant nature of this disease is not established. Its evolution is unpredictable and spontaneous regression after simple biopsy were described. The authors report four cases of Langerhan's cell Histiocytosis and will discuss on the clinical and radiological aspects as well as on the evolution of orbital histiocytoses X.

[Solitary eosinophilic granuloma of the orbit: a case report]. / Granulome eosinophile isolé de l'orbite. A propos d'un cas.

The authors report a case of eosinophilic granuloma involving the roof of the orbit in a 3-year-old girl. The clinical presentation and the imaging features suggested a malignant tumor and the final diagnosis was obtained by biopsy with histopathologic examination. Despite its alarming radiologic appearance, there was spontaneous healing of the eosinophilic granuloma.