[Spontaneous renocolic fistula from lithiasic pyonephrosis (author's transl)]. / Fistule réno-colique spontanée consécutive à une pyonéphrose lithiasique.

A patient developed a spontaneous communication between the left kidney pelvis and the descending colon following a lithiasic pyonephrosis. Signs of sepsis were present and diagnosis was based on urological findings only. Treatment consisted of left nephrectomy combined with a colectomy and an end-to-end anastomosis of the large intestine. The published literature is reviewed.

[Radiological signs of tumours of the adrenal glands (author's transl)]. / Signes radiologiques des tumeurs de la surrénale.

The authors discuss the radiological signs in 18 patients with an adrenal tumour. 7 of them had a Cushing's syndrome, 10 others a phaechromocytoma and the last had primary hyperaldosteronism. The diagnosis was made from the history, the clinical picture, hormone estimations and pharmacodynamic tests, whilts in the majority of cases the tumour was localised by radiodiagnosis. In all cases, there was hypertension, permanent in tumours of the adrenal cortex, paroxysmal or permanent in the cases of pheochromocytomas. We emphasise the importance of retro-pneumoperitoneum, as the radiological investigation of choice, in the localisation of adrenal tumours, especially pheochromocytomas, and in Cushing's syndrome. In cases of pheochromocytoma, one should follow carefully the blood pressure, during special radiological investigations, in view of the danger of a sudden rise or fall in blood pressure, the first is treated with phentolamine, the second with noradrenaline solution. Finally, a scan using I 131 19-iodocholesterol may be valuable in diagnosis and localisation of adrenal tumours; it has in particular given very encouraging results in the differential diagnosis of adrenal tumours with the clinical presentation of Cushing's disease.

Diagnostic and therapeutic problems in Cushing's syndrome. Series of 7 cases.

A series of 7 patients (all females) with Cushing's syndrome are presented. The syndrome was due to an adenoma of the cortex in 4 cases, to a carcinoma in 1 and to bilateral adrenal hyperplasia in another. In the 7th patient the cortical hyperplasia was due to a bronchogenic carcinoma (ectopic production of ACTH). Surgery was performed in all patients except 1. In 5 patients (adenoma, carcinoma) the diseased adrenal was removed. In 1 patient a left total and a right subtotal adrenalectomy were performed. Out of those 7 patients 4 survived and 3 died. 1 died a few hours after surgery, another 3 months after operation and the last one was never operated on.

Diagnostic and therapeutic problems in 10 cases of pheochromocytomae.

Ten cases of pheochromocytomae, of which eight were benign and two malignant have been considered. All patients presented with hypertension, either paroxysmal (7 cases) or permanent (3 cases). It is essential to emphasize that the initial symptomatology of these patients on their admission to the hospital was often atypical and misleading: in 2 cases, the symptomatology was urological, in 2 cases psychatric and in one digestive. Quantitative determination of catecholamines and their metabolites was positive in 7 cases out of 10. Retropneumoperitoneal insufflation combined with intravenous urography and tomographies provided valuable information in each case. The surgical removal of these tumours, which was unilateral and in normal position, in each case, was carried out without complications. Sudden blood pressure variations observed during the operation could be controlled without difficulty. In 6 patients, the blood pressure became normal and remained so for 4 years. In 2 other patients, the blood pressure came back to normal after the operation, but presented a slight increase 1 year later. Pheochromocytomae, which are often masked by a misleading symptomatology, must be systematically searched for in all hypertensive patients, despite the characteristics of the hypertension. Surgical removal, if done early enough, produces cure of the hypertension.