[Anatomical study of the verumontanum of the urethra]

Five samples of infra-montanal prostatic urethra, fixed in formalin and stored in liquid nitrogen at -30 degrees C were examined histologically. The results of this study demonstrated that muscle fibres of the striated sphincter extend as far as the level of the veru montanum. The proportion of rapid and slow striated fibres was identical. These striated fibres were mixed with smooth muscle fibres of the urethra. The density of innervation of this muscular tunic was found to increase closer to the striated sphincter; it is composed of equal numbers of adrenergic and cholinergic fibres.

[Urologic complications of renal transplantation. Role of the length of the ureter]

Four hundred and thirty renal transplantations have been performed over a 5-year period during which there was a switch of surgical technique towards uretero-vesical anastomosis. In this paper, the urological complications observed are studied according to the site of transplantation, the position of the kidney, the type of anastomosis and the length of the ureter. Kidneys that were transplanted in iliac position gave rise to more complications than those transplanted in pelvic position, and reversing the kidney increased the number of urological complications. The complication rate was 6.7% with the uretero-vesical anastomosis and 12% with the uretero-ureteral anastomosis. The best results were obtained when the kidney was transplanted into the iliac fossa in pelvic position with its upper pole upward and its ureter anastomosed with the bladder: in 274 transplantations performed with this technique the complication rate was 4.7%. This study of different types of transplantation shows that the main factor is the ureteral length utilized: the longer that segment of the ureter, the more numerous the urological complications.

[Prospective study of a triple immunosuppressive combination in renal transplantation: cyclosporin A-corticoids-azathioprine]

Cyclosporin A significantly improves patient and graft survival as compared with the conventional corticosteroid-azathioprine treatment. However, the results are the same, or even worse, when the cyclosporin A-corticosteroid regimen is compared with the corticosteroid-azathioprine-antilymphocyte globulin regimen. The authors have investigated a prednisone-azathioprine-low dose cyclosporin A combination in 46 high risk patients from a series of 117 renal transplantations performed in 1983. The actuarial patient and graft survival rates were as good as, but not better than, those obtained in 1982 in 106 patients treated with the conventional regimen which includes antilymphocyte globulin; they were 96.5% vs 98% and 85.5% vs 84% respectively at 6 months; 96.5% vs 98% and 83.5% vs 84% respectively at 12 months. The low dosage utilized (8 mg/kg instead of the usual 14-17 mg/kg) avoided virtually all the extrarenal side-effects of cyclosporin A, but not its nephrotoxicity. The theoretical risk of excessive immunosuppression was not confirmed by our study. Since cyclosporin A is very expensive, other therapeutic methods for optimal usage of that drug should be investigated.

Oxalic acid level in bronchoalveolar lavage fluid from patients with invasive pulmonary aspergillosis

Oxalic acid is a fermentation product of Aspergillus. We have measured the oxalic acid level in bronchoalveolar lavage fluids recovered from immunocompromised patients with and without invasive pulmonary aspergillosis. These levels were significantly higher in patients with invasive aspergillosis than in patients with pneumonitis of other causes. Thus, the determination of oxalic acid in bronchoalveolar lavage could be a presumptive argument for invasive aspergillosis until positive fungal cultures or histologic diagnosis; its potential value in monitoring the course of invasive pulmonary aspergillosis, particularly under treatment, has to be confirmed in more patients.

Need for hepatocellular carcinoma screening before renal transplantation in HBs +, HBe +, western African

We report a case of fulminant hepatocellular carcinoma discovered 50 days after renal transplantation. The recipient was a young Senegalese, hepatitis B virus chronic carrier. The pre-transplant check-up was normal, and the tumor was latent until its dramatic expression. Progression of hepatitis B liver disease occurs in immuno-suppressed renal transplant recipients, which often leads to chronic active hepatitis, cirrhosis and hepatocellular carcinoma, with a high risk of death due to liver disease. The early discovery of the tumor in this patient emphasizes the necessity for complete hepatic screening before transplantation in african, hepatitis B virus chronic carrier recipients. Moreover, the accumulation of risk factors for hepatocellular carcinoma: hepatitis B virus, food mycotoxins (aflatoxin), parasitic infestation and immunosuppression with transplantation is stressed.

[Continuous ambulatory peritoneal dialysis before renal transplantation]

In order to evaluate precisely the place of continuous ambulatory peritoneal dialysis in the treatment of chronic renal failure, it is important to find out whether this method may produce complications, mostly infectious, after renal transplantation. From April, 1979 to December, 1983, 419 renal transplantations were performed in our centre; 17 of these patients had previously been treated with peritoneal dialysis over a mean 13.5 months period, with 3.2 peritonitis/patient. The peritoneal catheter was left in situ for 4 to 16 weeks post-graft, so that the patients could easily be dialysed if needed; it was removed during transplantation in the only 3 cases of recent peritonitis. The only complications noted after transplantation were an episode of spontaneously reversible ascites and a peritoneal breach following reintervention on the renal region. This homogeneous series confirms that continuous ambulatory peritoneal dialysis does not constitute a contra-indication, let alone an obstacle, to subsequent renal transplantation. Indeed, it may be regarded as the first-choice method for patients in whom early grafting is envisaged on account of their immune status.

Bladder neck reconstruction using an anterior bladder flap in post-prostatectomy incontinence

Bladder neck reconstruction using an anterior bladder flap was used in 10 patients with total diurnal urinary incontinence, persistent 1 year after suprapubic (n = 6) or transurethral (n = 4) prostatectomy. 8 patients achieved symptomatic improvement, 6 of them with excellent or good results. Bladder neck reconstruction is undoubtedly able to correct post-prostatectomy incontinence, provided there is no residual bladder neck obstruction or alteration of the bladder musculature due to previous surgery. These cases should be considered for artificial sphincter implantation.

Anatomical study of total cystoprostatectomy

The authors describe an anatomical study of total cystoprostatectomy. They show that Denonvilliers' fascia is made up of many membranous layers starting at the bladder. They recall the fact that the preprostatic veins are attached at the bottom, not only to the venae dorsales penis, but also to the venae pudendae internae which runs under the levator ani muscle. These preprostatic veins lie inside a vessel-bearing blade of tissue made of muscular and collagenous tissue derived from the anterior vesical wall. This anatomical study recalls the fact that the interprostatorectal dissection line is behind Denonvilliers' fascia and that the preprostatic vein dissection line is on the anterior aspect of the membranous urethra.

[The medio-femoral approach]

The authors report a series of thirty A. profunda femoris dissections by anterior approach: the medio femoral way, which is enabled to isolate an arterial segment of six centimeters.

[Santorini's venous plexus]

This article provides an anatomical study of Santorini's venous plexus based on forty dissections. The authors present a sketch of the plexus and its housing and suggest surgical applications of this anatomic sketch.

Anatomical bases of kidney transplantation in man

Kidney transplantation is a well codified operation. The way to reduce surgical complications (urological and vascular) lies in a precise knowledge of the anatomy of the renal pedicle, as well as of the ureter and its vascularization. The choice of a site for implantation depends on anatomical arguments which aim at using a well vascularised ureter, and so a short one, and a renal pedicle without tension, with therefore a long or extended renal vein. A privileged site for transplantation is the right or left iliac fossa; transplantation in the lumbar fossa remains exceptional.

Anatomical basis of total prostatocystectomy in man

In the first part of this paper special emphasis is given to the anatomy of Denonvillier 's fascia which is derived from the prostatic capsule and covers the seminal vesicles, and to the preprostatic veins. In the second part devoted to the surgical technique of total prostatocystectomy the authors propose that the vesicoprostatic unit be freed by dissecting posterior to Denonvillier 's fascia. It is also proposed that the membranous urethra be sectioned prior to performing hemostasis of the preprostatic veins.

Anatomical basis of the surgical approach to the membranous urethra

The pars membranacea is the short segment of the urethra traversing the floor of the perineum. The main anatomical obstacles encountered in the approach to the membranous urethra are the perineal body posteriorly, and the deep dorsal vein of the penis and preprostatic venous plexus, anteriorly. These obstacles must be borne in mind when performing a surgical approach to the membranous urethra. The perineal body is the main obstacle to the perineal approach and can be avoided by incision of the sagittal raphes (anobulbar and rectourethral raphes) posterior to it and up to the apex of the prostate. When the trans-symphysial or transpubic approach is used, detachment of the suspensory ligament and roots of the penis allows exposure of the preprostatic venous plexus whose inferior part lies over the membranous urethra.

[Perinephretic phlegmon of pseudotumor form]

The authors report a case of perinephric phlegmon simulating a tumor. Ultrasound and CT scan were unable to provide grounds for correct diagnosis. It was only after incision of the mass and drainage of the purulent matter that a correct diagnosis could be made.

[Surgical significance of Denonvillier's aponeurosis]

This article provides a macroscopic and microscopic anatomical study of the structure of Denonvilliers' fascia, and suggests that it is embryologically connected with the anlage of the Wolffian duct, prostate and trigone.