Multiresistant corynebacteria in bacteriuria: a comparative study of the role of Corynebacterium group D2 and Corynebacterium jeikeium.

During an 11-month prospective study, urine cultures were performed on 5685 samples obtained in three hospital units. The use of a selective medium improved the recovery of antibiotic-multiresistant corynebacteria (AMC): 703 isolates (12.4%) compared with 88 isolates (1.6%) on sheep blood agar. Corynebacterium group D2 (CGD2) was isolated in 80.5% of urines yielding greater than or equal to 10(5) AMC ml-1 whereas Corynebacterium jeikeium represented 80.2% of isolates with less than 10(5) AMC ml-1. Among 16 patients with greater than or equal to 10(5) ml-1 C. jeikeium none had signs of urinary tract infection. In contrast, among 56 patients with greater than or equal to 10(5) CGD2, 40 (71%) had abnormal urinary sediment (mainly apatite or struvite crystals) and 29 (52%) had clinical signs of urinary tract infections sometimes complicated by lithiasis (seven cases) and alkaline-encrusted cystitis (two cases).

[Use of papillotome for antegrade treatment of ureteral stenoses and uretero-ileal anastomotic strictures under radioscopic control. Experimental study in dogs and clinical application]. / Utilisation du sphinctérotome par voie antégrade et sous contrôle radioscopique dans le traitement des sténoses urétérales et des anastomoses urétéro-iléales sténosées. Etude expérimentale chez le chien et application clinique.

A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.

Hormonal therapy trials in prostatic cancer. An EORTC Genitourinary Group study.

In this paper the authors review the completed and current EORTC Genitourinary Group trials for metastatic carcinoma of the prostate. In terms of time to progression and length of survival, there is no significant difference between any of the effective endocrine treatments that have been studied. The statistical analysis of the different variables used in trials 30,761 and 30,762 determines three risk groups of patients. There is no need for very special laboratory investigations to establish a prognosis. Orchiectomy is the cheapest and safest endocrine treatment in metastatic carcinoma of the prostate.

[Use of the pedicled transverse preputial flap in the surgery of hypospadias. Apropos of 100 cases]. / L'utilisation du lambeau préputial transverse pédiculé dans la chirurgie de l'hypospadias. A propos de 100 cas.

From August 1984 to July 1986, we performed 185 urethroplasties for hypospadias repair. 100 children underwent single stage correction with the transverse preputial island flap technique. The ages ranged from 8 months to 16 years with an average of 3 years. It was not the first operation for 10 children: 2 underwent staged operative procedures to perineal hypospadias reconstruction, 6 had previous hypospadias surgery by one or several other techniques. The follow-up interval ranges from 3 to 26 months (mean 11 months). The overall fistula rate was 14% (with spontaneous closure for 6%); proximal stricture rate was 2% and meatal stenosis rate 9%. 5 patients endured a meatal stenosis which facilitated subjacent fistula. Reoperation was necessary in 12 cases including 3 fistulae, 6 meatal stenosis (two of which were associated with subjacent fistula), 2 proximal stenosis; and one for extract bladder lithiasis. However 86 patients present an good cosmetic and functional result without complication. The Duckett's transverse preputial island flap technique is an undeniable progress for the hypospadias repair, with an acceptable complication rate.