[Priapism and activated protein C resistance]. / Priapisme et résistance à la protéine C activée.

Priapism is a rare disease that can be secondary to a clotting disorder. The authors report the first published case of priapism due to a heterozygous mutation of factor V Leiden responsible for activated protein C resistance in a patient treated with low molecular weight heparin. A similar case has already been reported, but with a homozygous mutation. Priapism must therefore be considered to be a thromboembolic event and the presence of a clotting disorder should be systematically investigated in the absence of an obvious aetiology.

[Management of severe renal trauma]. / Prise en charge actuelle des traumatismes graves du rein.

OBJECTIVE: To analyse the progress in the management of severe renal trauma (Chatelain stage 3 and 4) over a period of 11 years. PATIENTS AND METHODS: From December 1989 to June 2001, 21 patients were treated for severe renal trauma. Up until 1995, all patients were operated urgently or on the 7th day (n = 12). After 1995, patients were operated (n = 3) or managed nonoperatively (n = 6). We retrospectively studied the age, gender, type of trauma (open, closed), associated lesions, radiological assessment performed, treatment and complications. RESULTS: 20 males and 1 female with a mean age of 30.3 years were managed for severe renal trauma (17 stage 3 and 4 stage 4; 20 cases of closed trauma, 1 case of open trauma). The radiological assessment comprised ultrasound (13 cases), abdominopelvic CT (19 cases) and IVU (4 cases). Thirteen patients presented with multiple injuries with associated visceral (8 cases), bone (7 cases), or mixed (3 cases) lesions. Six patients were managed nonoperatively and 15 patients were operated: 6 urgently (4 total nephrectomies), 9 on the average of the 7th day (conservative treatment). Five patients developed long-term complications (4 cases of renal atrophy, 1 urohaematic pseudocyst). The median follow-up was 13.5 months. CONCLUSION: The current approach to stage 3 renal trauma tends to be surveillance and nonsurgical management (carefully selected, haemodynamically stable patients). Vascular repair before the 5th hour is recommended for stage 4 trauma. Cases of delayed diagnosis of arterial thromboses are monitored.

[Prognostic value of tumor location of urothelial tumors of the bladder, after total cystectomy]. / Intérêt pronostique de la localisation tumorale des cancers urothéliaux de vessie, après cystectomie totale.

OBJECTIVE: Comparison of the various treatment protocols for bladder cancer requires identification of survival prognostic factors. Some clinical parameters, such as tumour sub-site, have still not been studied. The authors therefore analysed the prognostic value of this factor, in combination with known prognostic factors, after radical cystectomy for urothelial bladder tumour. MATERIALS AND METHOD: 120 patients were treated for pure urothelial bladder tumour with pelvic lymphadenectomy, between January 1980 and January 1999, in a single centre. The prognostic value of the various sub-sites was studied by univariate and multivariate survival analysis. RESULTS: The 5-year survival decreased from 62% to 19% in the case of a lesion involving the bladder dome (p = 0.0001). Multivariate analysis demonstrated the following independent prognostic factors: local invasion pT < or = 3 (p = 0.003), lymph node involvement (p = 0.05) and involvement of the dome (p = 0.002). Other tumour sub-sites had an effect on survival on univariate analysis that was not confirmed on multivariate analysis. CONCLUSION: Although stages pT and pN are prognostic factors recognized by all studies, invasion of the bladder dome appears to have a major independent influence on survival. This result must be confirmed by other studies, in view of its potential influence for determination of homogeneous patient groups in controlled trials.