[Hemostasis of the preprostatic veins in total cystoprostatectomy. Anatomical bases]

An anatomical study has enabled the authors to propose a diagrammatic description of pre-prostatic veins, the haemostasis of which is one of the difficult stages in total cystoprostatectomy for cancer. These veins are surrounded by the pubovesical ligaments but they are separated from the membranous urethra by a cleavage plane which can be used to control venous bleeding.

[Arteriovenous-caliceal fistula following biopsy of a transplanted kidney. Treatment by selective arterial embolization]

This article reports a case of arteriocaliceal fistula following a kidney transplant biopsy. Hematuria and anuria were arrested by therapeutic embolic occlusion.

[Sarcoma of the bladder in adults]

The authors report five cases of sarcoma of the bladder and make a distinction between homotypical and heterotypical sarcomas and lymphosarcomas presenting specific therapeutical problems. The prognosis is severe because of very frequent local relapse. They recommend disregard of the invasion of the muscular wall, and the performance of total cystectomy following a positive histological diagnosis. In their view, this is the basis for the treatment of sarcomas.

[What are the indications for nephrectomy in candidates for renal transplants]

The kidneys of a patient with renal insufficiency often retain an endocrine role which should not be overlooked, and they are sometimes capable of residual diuresis. A case history of acute pyelonephritis, the existence of infected stones, or problems of infected reflux, are all indications for nephrectomy. On the other hand, arterial hypertension or an uninfected reflux do not, in our view, constitute indications for this procedure. In cases of renal polycystosis, only those kidneys whose volume constitutes an obstacle to transplantation should be treated surgically.

[Secondary tumors of the kidney]

The authors report twelve cases of secondary kidney tumors. In seven cases, they found antecedents of primary tumors, contrasting with the clinical, urographic and echographic data suggestive of a typical kidney tumor. Only arteriography, when performed, could visualize a hypovascularized tumor. The authors make a distinction between two situations: unilateral kidney tumors, which require total nephectomy, since, in 95% of cases, they are primary growths, and bilateral tumors, which require further exploration, since, in 20% of cases, they are metastatic proliferations.

[Removal of the kidney following in situ perfusion]

Kidneys of potential donors undergoing sudden cardiac arrest are generally not gathered because the warm ischemia time is too long until nephrectomy. A rapid in situ cold perfusion technique was developed to preserve kidneys in 21 brain-dead patients after cardiac arrest not responding to cardiac resuscitation. In 7 of the 21 potential donors, the in situ perfusion was unsuccessful. In 14 other subjects this technique permitted to save 15 transplantable kidneys; 1 month after grafting, the renal function was similar to that observed in kidneys gathered in living patients. The in situ perfusion technique allows to increase by nearly 10% the efficacy of kidney gathering.

[Spontaneous renal allograft rupture. Diagnosis and treatment. Report on five cases (author's transl)]

The authors describe five cases of renal allograft rupture as a result of acute rejection. In one case of perineal hematoma, no operation was performed. The evolution of the hematoma led to a periureteral sclerosis, which was successfully operated. The authors advocate deferring the surgical management of allograft ruptures. Once the diagnosis has been established with the aid of physical examination, electrography and computerized scanography, the extra time can be devoted to following the evolution of the rejection. If the rejection is irreversible, a nephrectomy has to be performed, but if it is reversible, they favour conservative treatment followed by operative intervention around the tenth day.

[What are waiting for chemotherapy in urology (author's transl)]

The place of chemotherapy inthe treatment of urological cancers remains imprecise. According to numerous publications, all urological cancers should benefit from chemotherapy. This review's goal is to point out the benefits that may be obtained with this type of treatment. Reduction of tumor volume, improvement of quality of survival, length of survival and toxic side effects are taken into account. Two different situations are considered: cases in which chemotherapy has proved to be efficient and should be prescribed, and, in most cases, situations in which chemotherapy is designed to help finding active drug and define efficient therapeutic protocols. This can only be indicated when prospective randomised studies are done in specialised centers with the collaboration of urologists and radiotherapists.

[Obstructive anuria (author's transl)]

In the last 10 years we observed 75 cases of obstructive anuria: 60% during the course of pelvic cancer; 27% took place on a remaining kidney; 26% were due to kidney stones, usually uric acid stones; 3 cases were secondary to remaining kidney hydronephrosis. Diagnosis was facilitated by high dose, late film IVP and by descending uteropyelograms, one of the most reliable diagnostic techniques in trigonal obstruction. Hemodialysis was used in 10% of the cases. Early surgical treatment was often made possible by the use of spinal anesthesia.

[The thyroxine hyperthyroidism (author's transl)]

24 of all patients observed between 1974 and 1976 suffering from thyrotoxicosis were found to have increased blood thyroxine (T4) levels without increased triiodothyronine ones. T4 hyperthyroidisms represented 3.5% of all hyperthyroidisms observed; they were in relation with Grave's disease (18 patients) or toxic nodular (6 patients); clinical pictures were quite usual; old age, severe illnesses, amiodarone and corticoids treatments, iodine excess, were sometimes being incriminated, but often no particular cause could be found. Preferential T4 secretion or impaired peripheral T4 conversion are two possible mechanisms of T4 hyperthyroidism.

[Diverticula of the duodenal window. 36 cases (author's transl)]

The authors have studied 36 cases of duodenal diverticula detected during 500 biliary operations. Initial pre-operative diagnosis was based on upper gastrointestinal barium series alone. Fiberopticduodenoscopy was unable to detect the diverticula. Patients were studied by cholangiocinesimetry. This technic demonstrated that oddian activity was satisfactory, with normal sphincter pressures and thus eliminated any suspicion of odditis. In this series, diverticula of the duodenal window lead to no more complications than do cholelithiasis, acute cholecystis or acute pancreatitis. The repercussion of the diverticula seems then to be limited to isolated dilatation of the common bile duct. In treating, the authors conclude that, in case of common bile duct dilatation, external drainage or biliodigestive anastomosis is recommended. Sphincterotomy is not indicated. All direct surgery on the diverticula, responsible for heavy morbidity and mortality rates, is to be avoided.

[Cytology in the diagnosis of prostatic cancer (author's transl)]

We are reporting our 20 years experience in the cytological diagnostic study of prostatic cancer. We studied at the same time, urinary cytology and prostatic histology in 217 patients. There were 50% false positive results with urinary cytology. Franzen aspiration enabled us to diagnose 81% of all prostatic cancers. These two methods are possible on an out-patient basis and enable us to determine high risk patients and to diagnose prostatic cancer earlier.

[Prostatic carcinoma: metabolic effect of percutaneous beta-estradiol (author's transl)]

Twenty one patients suffering from carcinoma of the prostate, confirmed histologically and previously untreated, received treatment in the form of 17 beta-estradiol administered percutaneously. At a dose of 6 mg of estradiol per day, testosterone levels fell to a mean of 1 ng/ml. No change in lipids, lipoproteins nor cholinesterase were detected.

Percutaneous 17 beta-estradiol in treatment of cancer of prostate

A natural estrogen, 17 beta-estradiol, was given percutaneously to 21 patients with untreated cancer of the prostate. The follow-up lasted three to six months, and the results of the survey were encouraging. The hormonal controls showed good plasma diffusion of estrogen, a significant drop in plasma testosterone, and decreased hypophyseal secretion as shown by lower follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Triglycerides and very low density lipoproteins (VLDL) which are considered to be good indicators of cardiovascular risk were unchanged.

[Chronic lymphocytic leukemia and cystadenocarcinoma of the kidney. A report of one case (author's transl)]

The association between chronic lymphocytic leukemia and a solid tumor is well known. When the leukemia appears before the tumor a question may be asked : is the tumor a cancer or a localisation of the leukemia ? When the cancer is diagnosed before the leukemia, an other question may be asked : is it a true leukemia or is it a paraneoplasic leukemoid reaction ?