[Study of the Ki-67 antibody immunolabeling of renal adenocarcinomas with or without renal vein thrombosis]. / Etude de l'immuno-marquage des adénocarcinomes rénaux, avec et sans thrombose de la veine rénale, par l'anticorps Ki67.

OBJECTIVES: The objective of this study was to compare the proliferation index (immunolabelling by monoclonal antibody Ki67 - MIB-1) of renal cell carcinomas as a function of the presence or absence of renal vein thrombus. Analysis of the numbers of Ki67-positive nuclei can be used to assess the degree of aggressiveness of the cell populations of these various carcinomas (tumour without thrombus, tumour with thrombus and neoplastic thrombus). METHODS: Twenty three renal cell carcinomas with renal vein thrombus were matched for Furhman grade (1st degree), tumour volume (2nd degree) and the patient's age (3rd degree) with 23 renal cell carcinomas not presenting any vascular embolus on histology. Monoclonal antibody MIB-1 immunolabelling was performed on 69 paraffin-embedded specimens: 23 tumours with thrombosis, the 23 corresponding neoplastic thrombi and 23 tumours without vascular embolus. RESULTS: A correlation between Furhman grade and the percentage of immunolabelled nuclei was observed (mean: 2.67% for low-grade tumours and 14.34% for high-grade tumours). No labelling difference was observed between the two populations of primary tumours (with thrombus/without embolus). Primary tumours presented significantly weaker Ki67 labelling than their corresponding neoplastic thrombus (mean of 2.47% versus 10.3%, p < 0.01). CONCLUSION: This study shows that there is no difference of the proliferation index between tumours with neoplastic venous thrombus and those with no histological vascular embolus. However, a difference of proliferation index was observed between the primary tumour and its corresponding thrombus, which presented a statistically higher immunolabelling. This finding suggests that the thrombus possesses more dividing cells than the primary tumour, i.e. has a shorter doubling time.

[Erectile dysfunction after radical prostatectomy: value of preoperative programming of intracavernous injections]. / Dysfonction érectile après prostatectomie radicale: intérêt de la programmation des injections intracaverneuses avant l'intervention.

OBJECTIVES: Vasoactive drugs used for self-administered intracavernous injections are currently the reference treatments for erectile dysfunction after radical prostatectomy. The acceptability of and compliance with this treatment often limit their use. This study analysed these two parameters as a function of the type of andrological management decided before radical prostatectomy. MATERIAL AND METHOD: From January 1996 to January 1997, 45 sexually active patients, aged 52 to 69 years, requiring radical prostatectomy without preservation of the nervi erigentes, for localized prostate cancer, were included in this prospective study. Before the operation all 45 patients were informed about the high risk of erectile dysfunction following radical prostatectomy. Fifteen patients (group 1) did not receive any particular advice concerning the management of erectile dysfunction after radical prostatectomy, but were possibly referred for an andrology consultation depending on their complaints. Fifteen patients (group 2) were systematically referred for an andrology consultation three months after radical prostatectomy for information about the available treatment options. For 15 patients (group 3), the andrology consultation (3 months after the operation) had been planned before radical prostatectomy to perform a test injection of prostaglandin E1. The injections, started before the operation in this group 3, therefore constituted an integral part of the global management of prostate cancer. All these patients were followed for at least 1 year in the urology department. RESULTS: Only 7 of the 15 patients of group 1 consulted an andrologist. Five of these patients received a test intracavernous injection versus 14 in group 2 and 15 in group 3. The 5 patients of group 1 who received an intracavernous injection accepted this modality as treatment versus 8 in group 2 and 12 in group 3. After one year, 4, 5 and 9 patients in groups 1, 2 and 3, respectively, continued intracavernous injections. CONCLUSION: The management of erectile dysfunction after radical prostatectomy must start with the decision to operate. Systematic encouragement to use intracavernous injections after radical prostatectomy helps to improve access to this treatment for impotence. The acceptability, and especially the compliance, appear to be better in patients in whom intracavernous injections were integrated into the global management of their prostate cancer.

[Survival and quality of life of patients with testicular cancer]. / Survie et qualité de vie des cancers du testicule.

Cisplatin has revolutionized the prognosis of testicular cancers. Stage I non-seminomatous germ cell tumours can be cured in 98% of cases; adjuvant therapy, chemotherapy or lymph node dissection, is recommended in high-risk tumours, while surveillance is indicated in tumours with a low risk of recurrence. Good prognosis metastatic non-seminomatous germ cell tumours are cured in almost 80% of cases at the cost of well tolerated chemotherapy, 3 BEP or 4 EP. The morbidity of lymph node dissection has been markedly decreased by means of various techniques of preservation of all or part of the sympathetic and lumbar contingent. Resection of residual masses after chemotherapy for metastatic non-seminomatous germ cell tumours is still recommended in the majority of cases. Stage I seminomatous germ cell tumours are cured in 98% of cases by 25 Grays of lumbo-aortic radiotherapy. Screening for carcinoma in situ in the contralateral testis to the primary tumour is controversial, but is recommended in the case of lowering of a maldesended testis after the age of puberty. Future paternity is a major concern in tumours of young adults, most of which are cured.

[Primary signet ring adenocarcinoma ofa diverted neurogenic bladder]. / Adénocarcinome primitif à cellules en bague à chaton sur vessie neurologique exclue. A propos d'un cas.

Primary signet-ring cell carcinoma of urinary bladder is an uncommon primitive bladder tumor. We report the first case occurring on a diverted neurogenic bladder. Except of adenocarcinoma of urachal origin, about 60 cases have been reported to date. The histogenesis of these tumors remains controversial.