[Neuroendocrine tumor of the bladder apropos of a case. Review of the literature]. / Tumeur neuroendocrine de vessie à propos d'un cas. Revue de la littérature.

Neuroendocrine bladder tumours are exceptional, and the positive diagnosis is only established when they are already large and advanced. We report an original case in view of its small dimensions. We discuss the differential diagnosis (mainly bladder metastases from lung cancer) and pathological specificities, particularly the value of epithelial immunolabelling allowing exclusion of lymphoma. Because of the similarities with bronchial neuroendocrine tumours, the potential value of serum NSE assay should be emphasized. Combined surgery-cisplatin-based adjuvant chemotherapy is recommended.

Transrectal ultrasonography in prostatic cancer: interexaminer variability of interpretation.

OBJECTIVE: To compare the variability of transrectal ultrasonographic (TRUS) interpretation for the decision of performing biopsies and the lesions to biopsy. METHODS: We extracted at random from our videotape database 16 records of patients who had undergone biopsies, added 2 normal glands and duplicated 2 of these 18 records. Based on the records, 5 well-trained physicians had to describe the images on the tape, and to decide whether or not to biopsy the prostate. A kappa test was computed between each couple of readers, and for the whole group. The kappa test denotes the agreement between examiners. A value of kappa < 0.20 is considered poor to slight agreement, 0.2-0.40 is considered fair agreement. RESULTS: The agreement between the 5 readers was poor for the biopsy decision (kappa < 0.2) and the difficulty to read the records (kappa = 0.05). The results with the global kappa were similar with a highest value < 0.3. Most of the abnormalities were described in the peripheral zone. The global kappa for the seminal vesicles interpretation is poor, but better for the capsular penetration. CONCLUSION: TRUS has a poor informative value between different practitioners. This poor agreement between different practitioners must lead to more objective ultrasonographic methods.

[Hot flashes and hormonal treatment of prostate cancer]. / Bouffées de chaleur et traitement hormonal des cancers de la prostate.

Androgen suppression in the context of the treatment of prostatic cancer is responsible for hot flashes in 75% of patients, which alter the quality of life to varying degrees depending on the patient. They constitute a source of major discomfort in 30 to 40% of patients. The pathophysiology of this effect is now known and involves: sex steroids, central opiates and intrahypothalamic catecholamines. The incidence of hot flashes appears to vary according to the type of hormonal treatment administered. The various treatments available are not equally effective. Non-hormonal treatments are of little value. Hormonal treatments: oestrogens and steroidal antiandrogens are the most effective. Progestogens also appear to be just as effective or even more effective than these other agents, with negligible adverse effects at the doses used in this indication.

Various features and surgical approach of solitary pancreatic metastasis from renal cell carcinoma.

In this paper we report three cases of solitary pancreatic metastasis from renal cell carcinoma (RCC), treated surgically. Various features and the surgical approach of these metastases are discussed with references to the 33 previous published cases collected in the literature. Having eliminated widespread distant metastases, it is reasonable to restrict surgical resection of the pancreas to selected patients having a single synchronous or metachronous metastasis, or those having several unilateral metastatic foci. At any rate a careful long-term follow-up for patients with a past history of RCC is mandatory.

[Medical treatment of disorders of the bladder sphincter]. / Traitements médicamenteux des troubles vésico-sphinctériens.

A lot of drugs can increase or decrease bladder activity or urethral sphincter activity. Some of them are used for treatment of incontinence or chronic retention. In case of severe pollakiuria or urge incontinence secondary to bladder instability, numerous medications can be used: anticholinergic agents, musculotropic relaxants, calcium antagonists, prostaglandin inhibitors, beta-adrenergic agonists, tricyclic antidepressants. Anticholinergic agents are regularly used on first choice. When stress incontinence is present, alpha agonists administered with estrogen and perineal reeducation represent the first stage before surgery. For medical treatment of retention, if there is not outlet obstruction, one can increase detrusor activity with betanechol chloride. In case of outlet obstruction, alpha-blockers or 5 alpha-reductase inhibitors can be used, if there is benign prostatic hyperplasia. Pygeum africanum can be used, but to date there is no clinical study proving its efficacy.

[Renal nephrogenic nephroma: an little known exceptional tumor. Apropos of a case disclosed by xanthogranulomatous pyelonephritis]. / Le néphrome néphronogène rénal: une tumeur exceptionnelle peu connue. A propos d'un cas révélé par une pyélonéphrite xantho-granulomateuse.

The authors report a new case of an exceptional benign renal tumour: nephronogenic nephroma, composed of differentiation of the blastema into primitive nephronic formations. It raises the problem of differential diagnosis with adult Wilms' tumour and renal blastematosis. In this patient, it was associated with segmental xanthogranulomatous pyelonephritis, presenting in the form of psoïtis and an abscess of the thigh. Total nephrectomy was performed.