[Pain and extracorporeal lithotripsy for calculi of the upper urinary tract]. / Douleur et lithotripsie extra-corporelle pour lithiase du haut appareil urinaire.

This study evaluates, 1) the pain induced by extracorporeal shock wave lithotripsy for renal stones using a piezo-electric shock wave lithotriptor (EDAP LT 01) and 2) the predictive factors for severe pain leading to an indication for analgesia. The relationship between extracorporeal shock wave lithotripsy intensity and pain intensity is evaluated by a numerical scale at the beginning of the session (T0), after 15 min (T15) and after 30 min (T30). At the end of the session, patients are categorized by one of us using a three-point scale which integrates the pain and the maximum tolerable intensity. These two types of evaluation are well correlated. Successive levels of stimulation are well discriminated by patients. Habituation is observed during the session for patients with low-level pain. In 28% of the patients, the intensity of pain required analgesia. Pain cannot be predicted by age, anxiety state, side of the stones and size, diameter of the contact between patient and convergence dome. In contrast, three parameters are correlated with the pain level: The L1 distance of renal parenchyma and the L2 distance skin-stone crossed by the piezoelectric waves, the size of the stone. The superior caliceal, middle caliceal and pelvic stones are significantly the most painful. These predictive variables can be easily measured before extracorporeal shock wave lithotripsy.

[Similar evolution, with cerebral metastases, of testicular cancers in 2 non-twin brothers]. / Evolution similaire, avec métastases cérébrales, de cancers testiculaires chez deux frères non jumeaux.

The authors describe two cases of germinal carcinoma of the testis. The two patients were brothers, but not twins. The evolution of the disease was the same in both cases, with cerebral metastases. The etiology was not discovered but the localization of the metastases in the brain would seem due to the fact the antimitotic drugs used in therapy failed to cross the brain blood barrier.

[Primary iliac arterio-venous fistula from spontaneous rupture of an atheromatous aneurysm (author's transl)]. / Fistule artério-veineuse iliaque primitive par rupture spontanée d'un anévrysme athéromateux.

The case of a patients, with a spontaneous arterio-venous fistula between the right common iliac vessels secondary to an atherosclerotic aneurysm of the artery, is presented. The authors, with the aid of the literature, recall the characteristic physical findings, the clues of the diagnosis and the modalities of the surgical treatment of such lesions. They insist on the importance of an early diagnosis as far as aneurysms are concerned, which allows to treat the lesions before complications arise.