[Mood and cognitive disorders, and androgen deprivation]. / Troubles de l'humeur et cognitifs et suppression androgénique.

Prostate cancer has become a chronic disease. In this context, it is important to take into account the quality of life of patients and their family in the therapeutic approach. Recent studies have demonstrated the importance of depression and the risk of suicide in patients with prostate cancer as well as the repercussions of the disease on the spouse and their relationship. The implication of hormonal treatment in the increase in risk of depression is difficult to affirm. Few studies have investigated this subject and they present methodological biases. Some authors report an increased risk of cognitive decline in patients on androgen deprivation. However, even if certain physiopathological hypotheses have been put forward, the imputability of the treatment on the alteration of cognitive functions has not been clearly established. Urologists are at the forefront of diagnosis and treatment of prostate cancer occurring most often in elderly subjects. Therefore, given the prevalence of depression syndromes and/or the alteration of cognitive functions in this population, the urologist must be aware of these different factors, which are potentially aggravated by the introduction of androgen deprivation. Based on a review of the recent literature, the authors suggest using a simple depression screening tool: confirmation of the diagnosis and management is within the competence of the general practitioner. As for the risk of cognitive decline, it seems difficult to imagine, and not necessarily relevant, to systematically propose a battery of neuropsychometric screening tests. On the other hand, giving the patient the G8 screening test can allow the urologist to assess whether the patient needs a geriatric consultation or not.

[Association of Bologna-type cervicocystopexy and Richter-type sacro-spinal fixation in low approach treatment of genital prolapse. Apropos of 18 cases]. / Association de la cervicocystopexie de type Bologna à la fixation sacro-spinale de type Richter dans le traitement par voie basse des prolapsus génitaux. A propos de 18 cas.

We report our experience with Richter spinofixation in association with Bologna cervicocystopexy. Eighteen patients underwent surgery for voluminous prolapse. Spinofixation did not lead to complications. This technique allows a vaginal approach in cases where only an abdominal operation was possible before. Incontinence results were similar to those with the Bologna procedure alone with the additional improvement of allowing a permeable vagina. Currently mean follow-up is 13 months, but these encouraging results suggest that this association should be continued in the future.

[Indications and tactical aspects of emergency colonic surgery in a tropical environment]. / Indications et aspects tactiques de la chirurgie colique d'urgence en milieu tropical.

As 92 emergency operations of the colon have been carried out, a record is given of their indications, the most prevailing being, in Africa, intussusceptions and volvulus of the pelvic colon. Out of 64 exercises and colic derivations, 42 ideal colectomies are used as a ground for the analysis of the requirements and limits of this emergency operation. As out of the 7 fistulas they have observed, 6 of them have been outcomes of exeresis of necrosed colic segments, the authors in accordance with the newest bibliographic data, emphasize the importance of mastering the anastomosis technique.

[Nuclear magnetic resonance imaging in the urologic study of the male pelvis. Apropos of 60 examinations]. / Apport de l'imagerie par résonance magnétique nucléaire (IRM) dans l'exploration urologique du pelvis masculin.

Theoretical concepts underlying the principle of nuclear magnetic resonance imaging are defined and the technical basis for its use in medical imaging described (sequences, accumulations, contrast media). Results are presented of a spectrometric study of 23 operative specimens from the bladder, prostate and seminal vesicles with analysis in vitro of relaxation time of the various tissues. Findings confirmed the value of NMR imaging for evaluation of macroscopic extension of tumors within the affected organs, as well as the interrelations of the organs, but the impossibility of identifying histologic structure of tumors and organs explored by this technique. Two groups of subjects were studied: a first group of 20 healthy volunteers to define NMR semeiology of male pelvis and a second group of 40 patients with mainly tumoral lesions of vesicles or prostate. Details are provided of the diagnostic value of NMR imaging with respect to the tumor, local and regional invasion and bone metastases. Excellent images of the tumor were obtained, with the possibility of determining its macroscopic stage, but its histologic nature could not be ascertained. Multiplane examination allowed better assessment of local and regional spread than by a CT scan, particularly for prostatic tumors (bladder, prostate bed or seminal vesicle extension). A negative feature of major importance exists, however, in that early glandular involvement is not detected by NMR imaging, which also fails to identify one case in two with bone metastases. Current research should allow progressive correction of present NMR imaging insufficiencies, notably in the field of tissue characterization.

[Iatrogenic carotid-cavernous fistulas, complications of carotid thrombectomy]. / Les fistules carotido-caverneuses iatrogènes, complications de la thrombectomie carotidienne.

The authors report four cases of carotid cavernous fistula at the C5 segment of the internal carotid artery following embolectomy by a 3F Fogarty Catheter. All patients were operated on a carotid bifurcation stenosis (pre-occlusive) and a thrombectomy with a 3F Fogarty Catheter was carried out in the same time in 3 patients and during re-operation in 1 patient who had post operative thrombosis. The carotid-cavernous fistula occurred the day after surgery in 2 cases, 1 week after in 1 case, and 2 months later in 1 case. Spontaneous recovery occurred in two patients (1 occlusion--1 re-stenosis), 1 patient died from controlateral carotid occlusion, and 1 patient was lost for investigation. There were no relationship between the number of "repeated passages" of the Fogarty Catheter and the interval time where the fistula occurred. However the location of fistula was constant. Overtension on the internal wall of the artery by the balloon could be advocated rather than a collateral torn of the intra cavernous internal carotid. Endoluminal treatment of various vascular lesion is increasingly used and iatrogenic problems as reported here should be kept in mind. Age and atheromatous lesion of carotid siphon appear to be the main risk factors.

[Iliac-femoral artery involvement in relapsing polychondritis]. / L'atteinte artérielle ilio-fémorale dans la polychondrite atrophiante.

A patient presenting a relapsing polychondritis with ruptured iliac arterial aneurysm and lower limbs arteritis is described. The analysis of the results compared with the literature's cases confirm the no response for surgical and medical treatments.

[Uterine rupture in Rwanda (apropos of 87 cases)]. / Les ruptures utérines au Rwanda (à propos de 87 cas).

The absence of obstetrical supervision and medical attention in dispensaries and health centers, the frequency of the hysterotomies are the reasons of numerous hysterorrhexis in Rwanda. This publication analyses the reasons and effects of this dreaded complications and proposes some prophylactic guidelines for this area of Africa, south of Sahara.