[Management of perianastomotic stenoses complicating vascular accesses for haemodialysis]. / Prise en charge des sténoses périanastomotiques compliquant les abords vasculaires pour hémodialyse.

OBJECTIVE: Perianastomotic stenoses (PAS) complicating native arteriovenous fistulas (AVF) of the forearm can be treated by angioplasty or surgery. The objective of this study was to report primary patency (PP) and primary assisted patency (PAP) rates of surgery and angioplasty of these stenoses. The secondary objective was to identify factors influencing the patency rates of these reoperations. MATERIAL AND METHODS: Seventy-three patients with a mean age, 65 years were treated for PAS between January 1999 and December 2005 in two centres (Tours and Le Mans), which were retrospectively included. PAS were treated by surgery (n=21) or angioplasty (n=52). The two groups were comparable. The mean follow-up was 39 months for the angioplasty group and 49 months for the surgery group (p=0.088). RESULTS: The PP rate was 71+/-10% for surgery and 41+/-6% for angioplasty (p<0.0175). The PAP rate was not significantly different (p=0.462) between angioplasty (92+/-4%) and surgery (95+/-4%). In the endovascular group, the site of stenosis on the anastomosis was a risk factor for early recurrence (95% CI between 0.006 and 0.392; p=0.047). CONCLUSION: These results suggest that anastomotic stenoses should be treated surgically rather than by angioplasty. Angioplasty and surgery give identical patency rates in other types of perianastomotic stenoses at the cost of a higher reoperation rate for angioplasty.

Human epididymal secretome and proteome.

The proteins that are neosynthesized and secreted in the different regions of the human epididymis were determined by in vitro biosynthesis of epididymal tubules, and the luminal proteins were collected by microperfusion of each tubule. The preparations were analyzed by two-dimensional gel electrophoresis and the proteins were identified by mass spectrometry. Some of the major proteins identified corresponded to serum compounds such as albumin, transferrin and alpha-1-antitrypsin. The other proteins identified included lactotransferrin, clusterin, PEBP, NCP2/CTP/HE1, HE3, Crisp, actin, calmodulin, E12, PGDS, l-lactate dehydrogenase, malate dehydrogenase, carbonic anhydrase, triose phosphate isomerase, glutamyltransferase, glutathione S-transferase P, thioredoxin peroxidase, superoxide dismutase, cathepsin D and cystatin. Epididymal activity is highly regionalized in most species. However, in this study in humans, there were only minor changes in the major proteins secreted. It is suggested that this specificity might be related to the difference between species in the location of the epididymis where sperm become fertile.

[National-ranking exams (NRE) in 2004. Students, faculties and university hospitals are awaiting the results]. / Les epreuves classantes nationales 2004. Premier classement pour les etudiants, les facultés et les CHU.

The results of the 2004 National-Ranking Exams supply interesting but preliminary information. Its intended goal is to rank the students, but it also provides qualitative and quantitative data about students, the success rates of various university teaching and research units (UFR - unité de formation et de recherche), the ranking for each of the 11 possible specialties, student mobility, and the relative desirability of the University Hospital Centres. In these first ranking exams, the medical and surgical specialties appear to be selected by students with the highest ranks, while less good scores lead to public health, occupational medicine. On an individual level, nonetheless, all combinations are seen.

Prevalence and risk factors of urinary incontinence in young and middle-aged women.

Objective To assess the prevalence of and risk factors for urinary incontinence (UI) in young and middle-aged women. Subjects and methods During 1998 the prevalence of overall, stress, urge and mixed UI was assessed in women working in a French academic hospital. Women (2800) received a questionnaire at the same time as their yearly interview with a staff physician in occupational medicine. The usual risk factors for constitutional events, i.e. increasing age, obesity (defined as a body mass index of > or = 25), obstetric events (pregnancy, previous Caesarean delivery, previous vaginal delivery, postpartum incontinence) and gynaecological events (hysterectomy) were evaluated. Results Of the 1700 women (mean age 40.0 years) who returned the questionnaire, 467 (27.5%, 95% confidence interval, CI, 25.4-29.7) reported UI, comprising 210 (12.4%, 10.8-14.0) with stress UI, 28 (1.6%, 1.1-2.4) with urge UI and 229 (13.5%, 11.9-15.2) with mixed UI. Thirty-eight women (8.1%) had frequent urinary leakage, comprising one (0.5%), four (14.3%) and 33 (14.4%) with stress, urge and mixed UI. The prevalence of UI increased significantly with age > or = 40 years, with a relative risk (95% CI) of 2.16 (1.86-2.57), and with pregnancy (2.22, 1.71-2.87), previous vaginal delivery (2.15, 1.72-2.69), postpartum incontinence (2.57, 2.22-2.97), and hysterectomy (1.52, 1.11-2.08). Obesity (1.14, 0.99-1.32) and previous Caesarean delivery (2.15, 1.72-2.69) did not significantly increase the risk of UI. The risk factors for stress UI were age > or = 40 years, pregnancy, previous vaginal delivery, postpartum incontinence and hysterectomy, but there was no relationship between stress UI and obesity or previous Caesarean delivery. Conclusion There was a high prevalence of UI among young adult and middle-aged women hospital workers who had easy access to medical resources. Gynaecological and obstetric events (pregnancy, particularly previous vaginal delivery and hysterectomy) were the most prominent risk factors, especially for stress UI.

Tumor progression and survival in patients with T1G3 bladder tumors: multicentric retrospective study comparing 94 patients treated during 17 years.

OBJECTIVES: To compare tumor recurrence, progression, and patient survival in T1G3 bladder tumors treated with transurethral resection (TUR) alone, early cystectomy, or TUR with an adjuvant 6-week course of bacille Calmette-Guérin (BCG) and followed up for a minimum of 5 years. METHODS: Between 1979 and 1996, 94 patients with T1G3 bladder tumors (lamina propria invasion) were treated at nine different centers. The time to tumor recurrence, tumor stage and grade progression, number of delayed cystectomies, and patient survival were analyzed retrospectively in relation to the initial treatment. RESULTS: The mean follow-up was 62 months. Thirty patients were treated by TUR alone (32%), 50 patients by TUR plus BCG (53%), and 14 patients by primary cystectomy (15%). The recurrence, progression, and cystectomy rates were significantly different between patients treated by TUR alone and TUR plus BCG (Fisher's exact test, P = 0.0005, P = 0.02, and P = 0.005, respectively). The disease-free survival was also significantly different when comparing TUR plus BCG with TUR alone or primary cystectomy (Kaplan-Meier analysis, log-rank test, P = 0.02). CONCLUSIONS: Endoscopic resection plus BCG treatment of pT1G3 tumors allows an 80% rate of disease-free 5-year survival with bladder preservation. This conservative option has been widely accepted as first-line treatment, offering good cancer control with excellent quality of life. Very accurate surgical and pathologic evaluations before treatment and lifelong follow-up are obviously required.

Intestinal perforation as a complication of tension-free vaginal tape procedure for urinary incontinence.

OBJECTIVES: To report and prevent a serious complication of tension-free vaginal tape (TVT) procedure. CASE REPORT: One day after a TVT procedure, an emergency CT scan showed adhesion of intestinal loops with a pneumoperitoneum. The patient had previously had intra- and retroperitoneal surgery with a sacral cervicopexy and a Burch colposuspension. CONCLUSION: In such a case of previous surgery, a CT scan may be useful before a TVT procedure.

[Results of an epidemiologic surgery carried out with men 50-80 years of age to study urinary disorders, quality of life and sexual function]. / Résultats d'une enquête épidémiologique menée chez des hommes âgés de 50 à 80 ans étudiant troubles mictionnels, qualité de vie et fonction sexuelle.

OBJECTIVE: The prevalence of urinary symptoms, their impact on quality of life and sexuality and the man's attitude in relation to these problem were studied by a self-administered questionnaire (including I-PSS, 6 questions of DAN-PSS-1, BPHQL9 and IIEF). MATERIAL AND METHODS: This questionnaire was sent by mail to a national representative sample of 3,500 French men aged 50 to 80 years. Of the 2,372 men who returned an interpretable questionnaire, 21%, 33% and 42% belonged to the severe or moderate category for symptoms, tolerance of symptoms, and alteration of quality of life, respectively. RESULTS: 81% of men reported sexual activity during the last 4 weeks. 8.3% of men were treated with "antiprostate" medical treatments, and 8% had been operated (16% of them were treated medically after the operation). Only 29% and 17% of men had talked about their sexual and urinary problems, respectively. CONCLUSION: Alteration of functional and perceived sexuality was correlated with age and the severity of symptoms in non-operated patients, but the poor correlations between scales evaluating sexuality and symptoms indicate that sexuality is a difficult aspect to investigate.

[Ureteral compression by mesenteric desmoid tumor. Report of 2 cases]. / Compressions urétérales par des tumeurs desmoïdes du mésentère. A propos de deux cas.

The authors report two cases of abdominal fibromatosis corresponding to Gardner's syndrome, causing hydronephrosis by extrinsic ureteric compression in young men in whom any form of surgical resection would have been in vain. These cases of ureteric compression were treated endoscopically by placement of a double J ureteric stent associated with treatment by tamoxifen in one case and sulindac in the other, with apparent stabilization of the disease. The two patients are regularly followed in the department with ureteric stent replacement two to three times a year.

[Classification and treatment of ureteroceles in the adult]. / Classification et traitement des urétérocèles de l'adulte.

Ureterocele or congenital pseudocystic dilatation of the terminal portion of the ureter due to persistence of Chwalla's membrane is frequent in female adults (17-35%) in its orthotopic form. It expands the short submucosal segment of the normally situated ureter and may be intravesical or extravesical. The diagnosis is primarily radiological based on intravenous urography (IVU) and endoscopy (urethrocystoscopy). Treatment depends on the site of the ureterocele, the clinical context, associated anomalies and especially the dimensions. Endoscopic treatment has numerous advantages and deserved to be more widely used.

[Discovery of a renal chromophobe cell carcinoma in a pregnant woman. Apropos of a case]. / Découverte d'un carcinome rénal à cellules chromophobes chez une femme enceinte. A propos d'un cas.

We report the case of a young pregnant woman with a malignant tumour of the kidney suggestive of oncocytoma. Because of the pregnancy, preoperative staging consisted of abdominal ultrasound and magnetic resonance imaging. Caesarean section was performed. Several days later, surgical exploration of the kidney was performed with tumourectomy and frozen section analysis: radical nephrectomy was finally performed. The definitive histology was chromophobe renal cell carcinoma. This is a rare tumour of the kidney, with its own characteristics allowing histopathological diagnosis and with a better prognosis than renal cell carcinoma. In the literature, pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.

[Nephrectomy for cancer in pregnant women. Apropos of a case]. / Néphrectomie pour cancer chez la femme enceinte. A propos d'un cas.

We report on the case of a young pregnant woman who had a malignant tumor of the kidney. The pregnancy did not change the gold standard therapy: radical nephrectomy. Because of the pregnancy the preoperative staging consisted of an abdominal ultrasound and a magnetic resonance imaging for the local extension, and of a chest X-ray looking for pulmonary metastases. According to the literature pregnancy, a situation of immune depression, does not increase the prevalence of malignant neoplasms.

[Retroperitoneal malignant fibrous histiocytoma]. / Histiocytome fibreux malin rétropéritonéal.

Malignant fibrous histiocytoma is the commonest soft tissue sarcoma of adults. The soft tissue of the extremities is the commonest primary site of malignant fibrous histiocytoma. It is much less common in the female retroperitoneum, leading to diagnostic errors. The clinical, radiographic and CT signs are non-specific. This tumor can only be diagnosed by histology. An initial complete resection is essential for successful treatment of the primary tumor. Radiation therapy is limited and chemotherapy has only been successful in a limited number of cases. This tumor has a poor prognosis. These lesions are relatively rare and consequently difficult to study. The authors report three cases and review the literature.

[Malignant fibrous histiocytoma of the retroperitoneum]. / Histiocytome fibreux malin rétropéritonéal.

The authors report two cases of retroperitoneal malignant fibrous histiocytoma which is a rare tumour (200 cases reported in the literature). The clinical and radiological signs are nonspecific and the diagnosis is based on histological examination of the specimen. Surgical resection must be as complete as possible to prevent local recurrence. The efficacy of adjuvant therapy has not been demonstrated due to the low incidence of this tumour.

[Surgical treatment of benign hypertrophy of the prostate]. / Traitement chirurgical de l'hypertrophie bénigne de la prostate.

It has been calculated that 7% of the males living in France over the age of 65% will undergo a surgical procedure for benign prostatic hyperplasia within 5 years. Currently approximately 65000 patients are operated every year. The mean age of the patients is 71.8 years with an incidence much lower than that observed in the United states where the mean age is 66 years. According to the reports of the 87th congress of urology, 10 to 20% of the patients are operated because of urine retention.

[The frequency of surgery of benign prostatic hypertrophy]. / Fréquence de la chirurgie de l'hypertrophie bénigne de la prostate.

OBJECTIVES: To calculate the incidence of surgical treatment of benign prostatic hyperplasia (BPH) in two French departments, Indre-et-Loire and C her, in order to deduce the incidence in France. METHODS: All patients operated for BPH by transurethral resection or transvesical prostatectomy were counted prospectively over a 6-month period by all surgeons of the Indre-et-Loire and Cher departments. Collection of case files was complete and based on BPH resection specimens sent to pathology. 506 patients were included in this survey. RESULTS: The mean age of the patients was 71.8 years. 78% of patients were operated by a private urologist, and 93% by a specialist urologist. The mean postoperative stay was 7.1 days and varied according to the patient's age, the weight of the prostate and the site of the operation (university hospital, private establishment and general hospital). This study allowed calculation of the annual incidence of surgery for BPH in these 2 departments: 822/100,000 men over the age of 50 years. The maximal incidence was observed during the 7th decade of life: 1,742/100,000. In our study, private urologists operated 76 patients for BPH per year. CONCLUSION: Extrapolation of these results to the French population indicates an annual incidence of surgery for benign prostatic hyperplasia in France of 776/100,000 men over the age of 50 years. On the basis of this incidence, an estimated 55,000 to 65,000 men are operated for BPH per year in France.

[Carcinoma in situ of the testis]. / Carcinome in situ du testicule.

Carcinoma in situ (C.I.S.) of the testis is the only known precancerous lesion of germ cell tumours. The prevalence and the incidence of C.I.S. are both unknown, although predisposing factors have been identified: history of germ cell tumour of the contralateral testis, cryptorchidism or history of ectopic testis, decreased fertility or sterility. The incidence is higher in the presence of a combination of several of these factors. No complementary investigations have been demonstrated to be of any value in the detection of C.I.S. which can only be diagnosed, at the present time, by means of surgical biopsy. Once C.I.C. has developed, it never resolves spontaneously. In one half of cases the C.I.S. evolves into an invasive tumour over a period of 5 years. There is no consensus concerning the population in which testicular biopsy should be proposed looking for C.I.S. A large scale C.I.S. screening and detection programme has been proposed in Denmark. However, it is not clear that there is any major gain in testicular cancer morbidity and mortality in comparison with a surveillance programme of patients at risk. Apart from conservative follow-up, two types of treatment can be proposed: orchidectomy or external beam radiotherapy which appears to eradicate the C.I.S. while preserving endocrine function.

[Epidemiology and detection of renal cancer in adults]. / Epidémiologie et dépistage du cancer du rein de l'adulte.

The incidence of renal carcinoma in France is 7 for 100,000 men and 3 for 100,000 women. Most cases are found in patients in their sixties or seventies. With the exception of the rare Von Hippel-Lindau disease, the only risk factor is tobacco smoking. The circumstances in which renal carcinoma is discovered have changed during the last few years: 1 out of 2 renal carcinomas are still diagnosed on their classical signs (essentially haematuria), but almost as many other cases are incidentally and unexpectedly detected by abdominal ultrasonography when the carcinoma is totally asymptomatic. The conventional attitude towards these fortuitously discovered renal tumours is the same as for asymptomatic tumours, i.e. widened nephrectomy. In case of small tumours a few centimetres wide, 20% of which are benign, it may be useful to wait a few months and reevaluate the situation prior to considering surgery. In elderly and asymptomatic patients the immediate surgical risk/long-term benefit ratio must be carefully weighed.