[Elastography shows promise in testicular cancer detection]. / Apport de l'élastographie en temps réel pour la caractérisation des masses testiculaires.

PURPOSE: Elastography is a novel imaging technology that shows promise in the identification of anatomic structures. The widespread use of ultrasound for screening testicular tumors in patients with cancer risk factors highlights unclassified testicular micronodules. We investigated the ability of elastography to accurately diagnose testicular nodules. MATERIAL: Patients with clinical testicular nodules were assigned to undergo elastography in a prospective study. The imaging was carried out by a single radiologist using a static elastography unit with a 9-14MHz frequency linear transducer, to identify hardness score, loss of architecture of testicular parenchyma, and surrounding effect. When orchidectomy was required, the corresponding specimens were subjected to hematoxylin and eosin staining for histologic correlation. RESULTS: We imaged 34 testicular lesions: 26/34 (76%) malignant tumors and 8/34 (24%) non-tumor lesion including 4 hematomas, 3 orchitis and 1 ischemia. Se, Sp, PPV and NPV of hardness in elastography in differentiating between malignant and benign tissue was found to be 96.2%, 37.5%, 83%, and 75%, respectively. Further, for recognizing cancer, the loss of architecture of the testicular parenchyma detecting in elastography was 92.3%, 75%, 92.3%, and 75%, respectively, and the surrounding effect was 84.6%, 87.5%, 95.6% and 63.6%, respectively. CONCLUSION: Elastography may be a promising tool at diagnosing testicular tumor when the loss of architecture and the surrounding effect were present. Further studies are needed to evaluate whether the utility of elastography is worth pursuing to identify of unclassified testicular micronodules. LEVEL OF EVIDENCE: 3.

[Repeat prostate biopsies following a first negative biopsy in a context of an elevated prostate specific antigen]. / Biopsies prostatiques itératives suite à une première biopsie négative dans un contexte d'élévation de l'antigène spécifique de la prostate.

INTRODUCTION: An elevated PSA and a negative prostate biopsy (PB) can be a false negative PB that ignores a prostate cancer (PCa) or a false positive PSA not related to PCa. The objective of this study was to analyze a group of patients who had a negative first BP for a PSA superior to 4 ng/mL and at least one additional PB and to compare these cases with controls who had the diagnosis PCa from the first PB. METHODS: Retrospective single-center study comparing patients with an elevated PSA and repeat biopsy following a first negative PB and patients with PCa diagnosed from the first PB. RESULTS: The 63 cases were younger than the 75 controls and had more often a normal digital rectal examination. Their prostate volume was larger and their number of PSA before the first PB lower: this corresponded to a lower PSA in the second (7/64), third (6/31), fourth (3/9) and sixth (1/1) PB. Among these cases with PCa, the length of core invaded by cancer and the total length of cancer of the entire PB were smaller than controls. In 76% of cases, the Gleason score among cases was 6 or less. CONCLUSION: PCa discovered on repeat biopsy had features of better prognosis than those of controls. We propose an algorithm for management of patients with elevated PSA and negative first PB.

[Characteristics of acute pyelonephritis in renal transplant patients]. / Caractéristiques des pyélonéphrites aiguës chez les patients transplantés rénaux.

INTRODUCTION: Renal transplantation is an attractive alternative to haemodialysis for patients with renal failure. Preserving renal function after renal transplantation depends on rejection episodes and infections of the graft. PURPOSE: To clarify the characteristics of acute pyelonephritis encountered in a population of kidney transplant patients and to discern risk factors occurring during the first year after transplantation. METHOD: Data for all renal transplantations between January 1, 2006, and December 31, 2007 came from a database. Patients were at least 18 years old. A retrospective analysis was done. RESULTS: One hundred and eighty-four patients were included in the study. The incidence of acute pyelonephritis was 10.9%. In our sample, there were significantly more women who experienced pyelonephritis (P=0.012). Patients who had grafts with at least one episode of acute pyelonephritis were significantly younger (P=0.013) than transplanted patients without a history of acute pyelonephritis (44.4±10.5 and 52.2±13.4 years, respectively). CONCLUSION: Our study shows a lower incidence of pyelonephritis compared with the literature. Moreover, we found that young age and female gender were risk factors for developing this infection.

Total, tartrate-resistant, and tartrate-inhibited acid phosphatases in serum: biological variations and reference limits.

We studied several factors affecting biological variation in serum acid phosphatases in a population of 1195 apparently healthy subjects four years old or older. We assayed total acid phosphatase activities in the presence of a transphosphorylating agent and using alpha-naphthyl phosphate as substrate. The main factors modifying total and tartrate-resistant acid phosphatases activities in serum are similar to those observed for total and bone alkaline phosphatases activities: age, sex, and hormonal state (puberty or menopause). The tartrate-inhibited acid phosphatase activity is, however, independent of biological variations. Finally, we propose reference limits for total, tartrate-resistant, and tartrate-inhibited acid phosphatases in serum.

[Sulfone-resistance of Mycobacterium leprae--monotherapy with diaminodiphenylsulfone--the value of triple-drug combinations]. / Sulfono-résistance de Mycobacterium leprae--monothérapie par la diaminodiphenylsulfone--intérêt des associations médicamenteuses triples.

While the emergence of drug resistance in Mycobacterium leprae was foreseen and known for a long time, it is now presented as a tragedy jeopardizing leprosy control through monotherapy. This resistance has been mainly reported in the United States. It is not observed in other parts of the world. In our opinion, the unfavorable observations made at present result from an incorrect implementation of dapsone (DDS) therapy in the patients, resulting in low sulfone blood levels, as a consequence of the use of complex disubstituted sulfones, insufficient daily dapsone dosages, irregular or noncompliance to treatment, premature interruption of treatment, etc. Two measures are required in order to prevent the emergence of primary or secondary resistance to dapsone in M. leprae. First, it is necessary to go back to the previous regimen of 200 mg dapsone daily in an adult. It yields the "maximum tolerated effective dosage." It should never have been rejected in favor of 100 mg daily as currently recommended at the moment. The second measure is the implementation of multiple drug therapy (MDT), using concurrently DDS in association with rifampin and clofazimine. This is a logical and rational approach, at least from a theoretical point of view. However, MDT is most unfortunately quite expensive and therefore inapplicable in most countries with high prevalence, since they are poor and underdeveloped. Implementation of MDT also raises great problems, since dosages have to be strictly adhered to in order to prevent a potentially catastrophic emergence of multiple drug resistance in M. leprae.

[Study of the molluscocid properties of lead triphenylacetate]. / Etude des propriétés molluscocides du triphénylacétate de plomb

The molluscicide and biocide properties of lead triphenylacetate (4,5 p p m, on Biomphalaria glabraia and Bulinus contortus) are not so great that the toxic action of tin tributiloxyde, on the same snails (2 p p m). Still the prices of the organic salts of lead are not so expensive as tin organic salts.