[Diagnostic and therapeutic problems posed by renal or para-renal masses of cystic appearances]. / Problème diagnostiques et thérapeutiques posés par des masses rénales ou para rénales d'allure kystique.

The authors report some forty cases of renal masses, cystic in appearance and having raised a certain number of diagnostic or therapeutic problems. These masses included 7 cystic carcinomas, 3 benign tumors of cystic appearance and 28 cysts including 2 infected and 2 hydatid cysts. No paraclinical investigation is infallible in confirming the nature of the mass in doubtful cases, and pre-operative diagnosis is more easily obtained by investigation including the majority of standard imaging methods often completed by puncture. Amongst clinical factors which raise doubts as to the benign nature of the cystic mass seen, hematuria remains the most important, other symptoms and signs being of little significance. With regard to imaging, septate calcified masses with echoes within them, with a thick wall or high CT scan density are theoretically suspect. The same applies to masses having rapidly increased at two successive investigations or where puncture fluid is bloody. In all cases if proof of the benign nature cannot be obtained, surgical exploration would appear to be required.

[Vascular anomalies of the kidney. Apropos of 3 cases]. / Anomalies vascularies du rein. A propos de 2 observations.

Two cases of rare vascular lesions of kidney are reported: a patient with a renal angioma and one with an aneurysm acquired after an oster type endocarditis. Both lesions were detected after severe hemorrhage and nephrectomy was performed in each case. Exact diagnosis was dependent on histopathologic findings. The relevant literature is reviewed.

[Study and treatment of erection disorders. Value of intracavernous injections]. / Exploration et traitement des dysérections. Intérêt des injections intracaverneuses.

A multidisciplinary study of 57 patients with erection disorders included in addition to standard examinations: clinical, hormonal, vascular using Doppler and nervous with determination of latency time of bulbocavernous reflex, evaluation of effects of intracavernous papaverine injections completed by a manometric study of cavernous body filing by perfusion. A clear positive result of the papaverine test is considered to reflect integrity of vascularization of corpus cavernosum structure, and renders value less the continuation of vascular investigations. The appearance of an almost normal but delayed erection requiring high-dose papaverine administration is interpreted as being due to insufficiency of arterial origin without anomaly of venous return. The absence of erection after papaverine injection, whether in the presence or absence of an increase in penis volume, results from excessive venous return, insufficient arterial supply or both. Absence of erection despite a cavernous perfusion of more than 70 ml/min is due to excessive venous return that requires localization by cavernography. The onset of erection during cavernous body filling eliminates excessive venous return and results from arterial insufficiency that necessitates pelvic arteriography. A therapeutic attitude of logical consequence is proposed.

[Acute epididymitis]. / Les épididymites aiguës.

A series of 86 cases of acute epididymitis observed over a period of 3 years is analyzed and findings reported. Testicular lesions were frequent and 35% of these cases involved a purulent testicular pocket. The epididymal lesion was usually of a total nature (77% of cases), only the tail of the epididymis being involved in 17%. Sterile urine was a frequent finding (50% of cases). Chlamydiae were rarely identified, but administration of medication ineffective against chlamydiae was effective in most cases, suggesting that these organisms are a rare cause of acute epididymitis. Iatrogenic epididymitis was a frequent diagnosis when compared with epididymitis due to cases of known cervico-urethral obstruction. Catheterization, endoscopic resection of prostate, transvesical prostatic adenomectomy were the main cause in the absence of ligature of deferens, the latter being considered as a certain preventive procedure. The affection is possible in children or adolescents (3 cases between 10 and 16 years) with an acute hydrocele as the presenting sign. Tuberculosis is still a possible cause (5 cases) with Koch's bacillus present in the urine in 4 of these patients. In the majority of cases, however, the etiology was unknown (62 of 86 patients = 72%). Treatment can be by a cycline as sole therapy, anti-inflammatory steroid or non-steroid agents also being effective. Medical treatment was rapidly and totally effective in 56 of the 86 patients, but residual foci were noted in 19 of 86 cases. Epididymectomy may be necessary for painful lesions or recurrence of epididymitis, while castration may be indicated (6 cases) for fistula formation, purulent pockets of testis, or ischemic necrosis of testis.(ABSTRACT TRUNCATED AT 250 WORDS)

[The vena cava in surgery of renal cancer in the adult]. / La veine cave dans la chirurgie du cancer du rein de l'adulte.

In a series of 171 radical nephrectomies performed by the authors, 10 patients presented vena cava extension (5.8%). The extension was infrahepatic (stage C) in 6 cases, retrohepatic (stage B) in 1 case and involved the right auricle (stage A) in 2 cases, while the upper limit of the thrombus could not be defined in the remaining case. All patients were operated upon. There was one post-operative death (stage B), while the other patients had an uncomplicated post-operative course, despite the need for open-heart surgery in two cases. Seven patients died from metastatic after an interval of 2 and 4 years. The prognosis is therefore reserved, but seems to be better than in the case of lymph node metastases, justifying an aggressive surgical approach.