Anatomic basis of pathology of the urachus.

The urachus, derived partly from the allantoic canal, tethers the apex of the bladder to the umbilical ring. This vestigial structure, though constant in man, is formed by a whole series of embryologic mechanisms which are still controversial. Total or partial persistence of the lumen of the urachal canal, when sufficiently extensive, becomes manifested by characteristic clinical features. Moreover, it is frequently associated with malformational urogenital involvement, which must be routinely sought. The sole form of treatment consists of total surgical excision of the urachus.

[Evaluation of a three-year (1988-1990) prenatal screening of malformative uropathies in the department of Puy-de-Dôme]. / Bilan du dépistage anténatal des uropathies malformatives sur 3 ans (1988-1990) dans le département du Puy-de-Dôme.

During a 3-year period, 93 prenatal diagnoses of kidney or urinary tract abnormalities were carried out in the French district of Puy-de-Dôme. Sixty-nine mothers were resident in this area giving an incidence of 2.8 out of 1000 births. The pregnancy was interrupted in 10 cases, there were 2 stillbirths and three infants died within two months of life. The most frequent abnormalities were: hydronephrosis (48% of cases), megaureter with or without ureter duplication (19%) and multicystic dysplasia (16%). The prenatal diagnosis was confirmed after birth in 82% of cases. Of the 56 infants with obstructive uropathies, 17 underwent a pyeloplasty within three months of life, 32 had conservative treatment, of whom 4 were operated on afterwards, and seven could not be traced. Of the seven infants who had normal ultrasound scan at birth, three had abnormal scan during the follow-up one of whom was operated on. Nephrectomy was not performed in any of the 11 cases of multicystic dysplasia: one patient was lost to follow up, three had stable lesions and in seven cases, the size of the cysts decreased.

[Composite carcinoma of the prostate combining a small cell carcinoma and an adenocarcinoma. Apropos of a case]. / Carcinome composite de la prostate associant carcinome à petites cellules et adénocarcinome. A propos d'un cas.

A case of combined adenocarcinoma and small cell carcinoma of the prostate is described in a 58-year-old-man. Prostatic acid phosphatases and neuron specific enolase were found elevated in the serum. At autopsy the lung was free of tumor. The liver was replaced by numerous metastatic nodules and a voluminous mesenteric metastasis extended into the wall of the vessels (aorta and vena cava). Microscopic examination showed a small cell carcinoma component of the oat cell type and an adenocarcinoma component constituting 10% of the total tumor volume. By immunostaining, the small cell carcinoma component is neuron specific enolase+ and prostatic specific antigen-. The adenocarcinoma component is neuron specific enolase- and prostatic specific antigen+.

[Technic and results of lymph node excision using pelvic lymphadenoscopy]. / Technique et résultats du curage ganglionnaire par lymphadénoscopie pelvienne.

The authors report their experience of a surgical approach to pelvic lymph nodes based on a series of 24 patients with prostatic cancer (20 patients) or bladder cancer (4 patients). After making a short iliac incision, this technique consists of detaching the peritoneum with a finger and introducing a retractor (modified Cusko speculum) allowing removal of the lymph nodes. The authors discuss the indications for this technique in comparison with other methods of investigation of lymph nodes and present their results.

[Extracorporeal lithotripsy. Apropos of 145 initial patients treated in Clermont-Ferrand]. / Lithotripsie extra-corporelle. A propos des 145 premiers malades traités à Clermont-Ferrand.

Between April and July 1987, 145 patients (presenting with a total of 178 renal and ureteric stones) were treated by extracorporeal lithotripsy (EDAP LT 01) in the Urology Department of Clermont-Ferrand hospital. No anaesthesia was performed during the 186 sessions required, except for 1 patient who underwent neuroleptanalgesia. Fragmentation was obtained in 86% of cases; the complete success rate was 70%, the partial success rate was 16% and the failure rate was 14%.

[Organ procurement. The Clermont-Ferrand experience]. / Prélèvements d'organes. Expérience de Clermont-Ferrand.

The authors report the experience of a new kidney collection centre organised at Clermont-Ferrand, which rapidly became involved in the collection of multiple organs. The difficulties encountered during the collection of organs from the first 30 cadavres are presented: 19 kidneys were not grafted, sometimes for anatomical reasons, but especially because of surgical reasons (during the following period, this number fell to 3 for a series of 21 cadavres). 13 hearts and 2 livers were also removed. In conclusion, the authors stress that such organ collection centres can only be created when transplantations are also performed, because of inevitable psychological reasons affecting both the health care team as well as the population of the region.

[Kidney pelvis perforation due to a Greenfield intra-caval filter]. / Perforation pyélique par un filtre endocave de Greenfield.

The authors report a case of renal pelvic perforation discovered three months after insertion of a Kimray Greenfield filter on an IVP in the form of a contrast leak. This complication was favoured by the initial malposition of the filter. Computed tomography was essential in the understanding of the pathology and in the investigation of associated lesions (uric acid stone). Treatment was conservative.