[Therapeutic strategy for Wunderlich syndrome]. / Stratégie thérapeutique du syndrome de Wunderlich.

Spontaneous retroperitoneal hemorrhage from the kidney was first described in 1700 by Bonet. Wunderlich gave his name to this rare syndrome in 1856. Up to now, 250 cases are reported. This disease entity is associated with an underlying pathology, which may be a benign tumor such an angiomyolipoma or a malignant tumor such renal cell carcinoma. We report two cases whose presenting features were those of this syndrome. We discuss the radiological characteristics including intravenous pyelography, renal angiography, computerized tomography and magnetic resonance imaging. Preoperative diagnosis is corroborated by surgical exploration and radical nephrectomy. We conclude in recommending computerized tomography as the examination of choice.

[Contribution of Abrams Griffiths' graphic charts in the analysis of urinary urgency in women]. / Apport de l'expression graphique selon Abrams Griffiths dans l'analyse de l'instantané mictionnel chez la femme.

The simplest way to obtain a meaningful result about detrusor pressure and urethral function is to have the plot superimposed on the Abrams-Griffiths nomogram. This concept is used to obtain information related to subvesical obstruction due to prostatic hypertrophy in male. We show herein that this type of analysis allows an objective estimate of pressure-flow relationships and permit simplification in analyzing micturition in women.

Simulation of appendicitis by tumor-like lesion of cecum.

Four cases are presented in which an initial diagnosis of appendicitis was made. At laparotomy, a cecal lesion simulating a tumour was found. Pathological examination showed inflammatory granulomatous tumour against foreign body, non specific ulcer, diverticulitis and acute solitary diverticulitis. When malignancy is excluded, hemicolectomy is not necessarily the best treatment and we propose conservative management for these patients.

[Leiomyosarcoma of the kidney]. / Le leiomyosarcome du rein.

Leiomyosarcoma of the kidney is a rare neoplasm. Diagnosis is obtained by CT-Scan and immunohistochemical study. Radical nephrectomy is the only therapeutic way whose efficacity is known. The authors report a case of two localisations (kidney and bladder) of leiomyosarcoma.

[Association of an appendicovesical fistula and an appendiceal adenoma. Case report]. / Association d'une fistule appendico-vésicale et d'un adénome de l'appendice. Rapport d'un cas.

A new case of appendicovesical fistula is reported. A hundred cases of such fistula are described in the literature. Usually the origin is appendicitis. Cecal diverticulitis, cystadenocarcinoma or carcinoid tumours of appendix are other less common causes. In one case, association with neuroma of appendix is found. We report a case of appendicovesical fistula caused by papillo-villous adenoma of appendix. In this case, echography and cystoscopy were helpful in management of diagnosis and planning for the therapeutic approach. Only two other cases of benign tumour of appendix forming fistula are reported in the literature.

[Correlation between volumetric endosonography and prostate weight. Variation according to histological type]. / Corrélation entre volumétrie endosonographique et poids prostatique. Variation selon le type histogigue.

Correlation between endosonographic volumetry and prostatic weight, accuracy according to histopathology. We report a study over 50 patients who underwent TURP, demonstrating statistical correlation between endosonographic volumetry and prostatic weight. We observe a difference in accuracy according to histopathology and we discuss the reliability of the technique. We conclude that variability is due to the sensitivity of the examination.

Appendicovesical fistula associated with papillovillous adenoma of the appendix.

Appendicovesical fistulae represent 5% of all intestinal vesical fistulae. Usually a known cause is appendicitis, cecal diverticulitis, cystadenocarcinoma of the appendix and carcinoid tumors. We report the 2nd case, to our knowledge, where a benign tumor is a possible reason for the formation of an appendicovesical fistula.

[Hypernephroma with contralateral renal artery stenosis. Therapeutic choices]. / Hypernéphrome avec sténose de l'artère rénale controlatérale. Choix thérapeutique.

We report a case of renal adenocarcinoma with contralateral stenosis of the renal artery. We describe the causes of hypertension in renal cancer and investigative techniques leading to the discover of a vascular implication in hypertension. We debate of the different surgical techniques for renal revascularisation with special regard to splenorenal anastomose. This is the method of revascularisation used in this case.

[Prosthetic replacement in a case of invasion of the inferior vena cava by a recurrent hypernephroma]. / Remplacement prothétique cave dans un cas d'envahissement de la veine cave inférieure par une récidive d'hypernéphrome.

We report a case of inferior vena cava resection and reconstruction for recidivant renal cell carcinoma. We describe the collateral circulation of the renal veins and its importance in the treatment of inferior vena cava involvement. We debate of the indications and of the different surgical techniques for reconstruction of the inferior vena cava.

[Correction of ureteropelvic junction syndrome: Anderson-Hynes method of pyeloplasty with or without nephrostomy]. / La correction du syndrome de la jonction pyelo-ureteral: pyeloplastie selon Anderson-Hynes avec ou sans néphrostomie.

We report the last 50 ureteropelvic junction repairs (Anderson-Hynes pyeloplasty) with a minimum follow-up of 6 months performed in our department. We describe the operative technique without nephrostomy in 40 patients and we look at the results in relation to a small group which had a nephrostomy for one or other reason (10 patients).

[Determination of the activity of extracts of Echinaceae and Sabal in the treatment of idiopathic megabladder in women]. / Mesure de l'activité des extraits d'Echinaceae et de Sabal dans le traitement des mégavessies idiopathiques chez la femme.

30 patients (25 to 76 years old), suffering from incontinence (18), pollakiuria (6) and dysuria (6) reveal at the urodynamic investigation (urovideo 2100 and neuromatic 2000M) an idiopathic large hypotonic bladder. 20 have been treated by Echinaceae (84 to 112 mg/a day) and sabalae (78 to 104 mg/a day) extracts (URGENIN: 90 to 120 drops/a day) during a mean time of 77 days. 10 have received 90 to 120 drops/a day of a placebo during a mean time of 52 days. The statistical evaluations have been carried on accord the STUDENT test for small numbers corrected by the FISHER factor. After placebo no modification of the symptomatology and no significant difference in the measures have been registered. After Urgenin: the bladder capacity, the residual urine and the compliance are significantly decreased; the detrusor pressure and the peak flow are significantly increased. The uretral pressure, the closure pressure and the uretral instability show a non-significant decrease. The modifications of the profilometers and sphincter EMG are not significant. In two cases bilateral vesico-renal refluxes have disappeared. The results of the study suggest that the neurotransmission is facilitated and that the smooth muscle fiber is activated by URGENIN. They measure the positive activity of Echinaceae and Sabalae extracts in the treatment of female idiopathic large hypotonic bladders.

[Ultrastructural modifications of the bladder wall in senescence]. / Modifications ultrastructurales de la paroi vésicale au cours de la sénescence.

Histochemical and ultrastructural studies of the epithelial, muscular, connective, vascular and nervous tissue layers have been carried on endoscopic or surgical biopsies in patients from 23 to 92 years old. Beyond 70 years old, the junctional complexes between the superficial cells of the epithelium are altered and the number of intracellular organelles is diminished. The intercellular spaces and binds between the muscle cells are modified. Some interstitial fibrosis occurs and the density of the connective tissue increases. The authors describe also similar observation in the bladder wall of the old rats. An arteriosclerosis of small vessels is observed. The density of the autonomous nervous network is reduced and the cholinergic innervation becomes preponderant. No specific ultrastructural modification of the nerves is seen except a neuromuscular infiltration by a conjunctive hyperplastic tissue. These morphological changes can be related to some modifications of the vesical compliance.

[Changes in intrinsic autonomic innervation in congenital or primary megabladder]. / Altérations de l'innervation neurovégétative intrinsèque dans les mégavessies congénitales ou primaires.

In eleven non-diabetic women suffering from high compliance bladder, the authors correlate urodynamic findings with the modifications of the autonomic vesical innervation. Endoscopic biopsies show a dramatic reduction in acetylcholinesterase-positive innervation in the detrusor but less visible in the trigone. The adrenergic network density is also reduced in both areas, according to age. Congenital conditions, high pressure mechanisms, vascular hypoxia explain these autonomic alterations inducing iatrogenic problems associated with different drug treatments. In some cases, urethral hypertonic instability acts in the same way as mechanical obstruction.

[Evaluation of the density of acetylcholinesterase-positive and intrinsic adrenergic innervation of the uterus in rats]. / Evaluation de la densité de l'innervation acétylcholinestérase-positive et adrénergique intrinsèque de l'utérus chez le rat.

According to the Karnovsky and Roots modified by E1 Badawi and Schenk's technique for the acetylcholinesterase-positive innervation and according to the Lindvall and Björklund modified by de la Torre and Surgeon's method for the adrenergic one, we have demonstrated the nervous fibers in the different tissues of the cervix, the corpus and the cornu of the she-rat in pro-oestrus. A statistic evaluation of the density of these nervous networks has been established for the different regions. The study of the histograms demonstrates the predominance of acetylcholinesterase-positive innervation versus the adrenergic one. The evolution of the nervous densities is similar for each tissue in the corpus and the cornu, these of the myometrium are the highest. In the cervix, the acetylcholinesterase-positive fibers dominate over the mucosal and submucosal ones, on the other hand, the adrenergic ones are richest in the muscle. Our morphometric studies confirm statistically the optic observations of the others authors.

[Cholinergic and adrenergic innervation of the bladder obstructed by urethral stenosis in the rat]. / L'innervation cholinergique et adrénergique de la vessie obstruée par sténose de l'urètre chez le rat.

In the obstructed bladder by urethral stenosis the morphometry studies show a decrease of the cholinergic and adrenergic intrinsic innervation in a different way according the tissue layer and the experimental delay. Adrenergic nerves are more affected than cholinergic ones but they recover more quickly. In the adventitia and the sub-mucosa first affected by the high pressures inside the bladder the density of the autonomous nerves decreases from the first week. The perivascular and muscular nervous fibers are less sensitive and the similar shape of their innervation histogram gives evidence of a tight bond between their adrenergic network. Beside their motor participation the adrenergic terminal fibers may play a role in the cellular trophicity of the muscle.

[Modification of the tissue thickness of the bladder in obstruction by urethral stenosis]. / Modification des épaisseurs tissulaires de la vessie au cours de son obstruction par sténose urétrale.

In experimental obstructed bladder by urethral stenosis, the trigone and the detrusor walls thicken in a very important but different way. The thickened mucosa and submucosa of the total bladder show oedema and hypertrophy of the connective fibro-elastic tissue. Related to the different axis of the pressure inside the bladder and the specific muscular architecture of both regions, the adventitial and muscular layers show no modification in the trigone but they become thinner in the detrusor.

[Density of the neurovegetative innervation of the uterus of rats]. / Densité de l'innervation neurovégétative de l'utérus chez la ratte.

Using the Karnovsky and Roots modified by E1 Badawi and Schenk's technic for the cholinergic innervation and with the method of Lindvall and Björklund modified by de la Torre and Surgeon for the adrenergic ones, we demonstrate the innervation of each tissular layer, in cervix, corpus and cornua of the uterus of the she-rat in pro-oestrus state. A statistic evaluation is established for the different areas. The density of cholinergic innervation is richer than the adrenergic one. The number of cholinergic fibers is maximum in the cervix. It decreases in corpus and cornua especially in the mucosal and sub-mucosal layers. The density of the muscular nervous network is predominant in the corpus versus the cervix. The number of adrenergic nerves is maximum in corpus it diminishes in the cervix and the cornua. In each region, the muscular adrenergic network domines over the other tissular layers. We confirm statistically morphometric non parametric observations of these other authors.