Extracorporeal shock-wave lithotripsy to remove calcified ureteral stents

A patient was seen with a large calcification of the renal end of a silicone catheter placed to intubate a cutaneous ureterostomy. Because of the stone, withdrawal of the catheter was impossible, and the patient presented with obstruction and dilatation of the renal cavities along with febrile bacteriuria and renal failure. Extracorporeal shock-wave lithotripsy, done under intravenous sedation, was found to be an effective noninvasive method to treat such a complication of long-term urinary drainage.

Clinical experience with a new pulsed dye laser for ureteral stone lithotripsy

We treated 45 patients (46 ureteral stones) with a new pulsed dye laser. A 250 mu. fiber was used through a rigid (40 stones) or flexible (6) ureteroscope. Stones were in the upper (5 cases), middle (5) or lower (36) third of the ureter. Stone composition was calcium oxalate dihydrate (34 patients) or monohydrate (7), struvite (2) or uric acid (2). Of the calculi 36 (78%) were fragmented, including 14 that also required simultaneous basket removal of fragments. Ten stones were not fragmented: 6 because of the pure monohydrate composition and 4 due to malfunction of the laser. No damage to the ureteral wall was noted. Retrograde rigid ureteroscopy with laser lithotripsy was effective for lower and middle third ureteral stones. Flexible ureteroscopy with laser lithotripsy was effective (impacted stones) but difficult for upper third ureteral stones.

Laser lithotripsy of ureteral calculi: initial experience with a new pulsed dye laser

Thirty-two patients with ureteral calculi ranging in size from 5 x 5 to 12 x 18 mm underwent lithotripsy with a new pulsed dye laser (Pulsolith, TMI). In 24 cases, the patients were entirely free of stones following laser lithotripsy alone, or with adjunctive stone basket removal. There were three instances of equipment failure and five calcium oxalate monohydrate stones that did not respond to laser energy.

Genitourinary tumors and HIV1 infection

4 patients with solid genitourinary tumors and HIV1 infection have been treated in our institution over the last 2 years. Two patients had seminoma, 1 renal adenocarcinoma and 1 renal angiosarcoma. All had deeply impaired immunity with a low CD4 level. 3 had or developed a true AIDS syndrome according to the WHO and CDC criterias of 1988. The remaining patient was seropositive and died less than 3 months following the diagnosis of renal angiosarcoma. He is the first reported case of renal sarcoma in a patient infected with HIV1. 2 patients were homosexuals, and the 2 others were drug addicts. Along with other reported cases, our cases underline the association between the depression of immunity due to HIV and the onset of solid genitourinary tumors.

[Benign prostatic hypertrophy. Treatment using local hyperthermia]

The authors have used local hyperthermia in the treatment of benign prostatic hypertrophy (BPH). The "Promeditech" device consists of a computer-controlled microwave hyperthermia system which warms up the prostate through a probe inserted into the rectum. Forty-three patients aged from 57 to 81 years were treated. All presented with severe voiding symptoms and were considered for surgery. Treatment was applied once a weeks for 5 weeks without anaesthesia and on an out-patient basis. At each session, hyperthermia was maintained at 42.5 to 43.5 degrees C for 60 minutes. Objective and subjective criteria for treatment were: post-voiding residual volume, voided volume, maximum flow rate and frequency, urgency, dysuria and nocturia respectively. These parameters were determined for all patients before and after treatment. Results were evaluated at 3 months and 6 months. Objective improvement was observed in 45 p. 100 of the patients, and subjective improvement in 58 p. 100. In 4 out of 5 patients fitted with an in-dwelling catheter for more than 3 months, it was possible to remove the catheter. This procedure must be more widely tested, but it seems to be particularly appropriate for two kinds of patients: those who do not accept retrograde ejaculation and those who are considered poor surgical risks.

[Treatment of epidermoid carcinoma of the penis]

Epidermoid carcinoma of the penis is a rare type of cancer. Treatment of the primary lesion consists of amputation, although curietherapy can be effective in some cases as a conservative treatment. The prognosis is determined by the presence of absence of lymph node invasion, but the therapeutic strategy to be used when invaded lymph nodes are present remains controversial. Lymph node dissection is the only effective treatment of metastatic adenopathy, but its high morbidity rate limits its indications.

Delayed nonurothelial metastatic lesions to the penis: a report of two cases

Metastatic lesions to the penis are uncommon and originate most often from other genitourinary primaries. Diagnosis is usually easy, as the primary is already known in most cases. The metastases can very rarely be isolated and delayed for several years after the treatment of the primary tumor. We report two cases of penile metastases from nonurothelial primary lesions. A sigmoid adenocarcinoma was the primary in one case, a renal adenocarcinoma in the other. These two cases were distinctly unusual, as the metastases were delayed for several years after the treatment of the primary. Treatment was palliative with early death in both cases.

[Treatment in a ventral position of vesicovaginal fistula by ordinary suture or autoplasty of the labia majora]

The authors describe a modification of technique which improves the exposure of vesico-vaginal fistulas treated surgically by a low approach. The patient is placed in a ventral horizontal position with the thighs in abduction, and the buttocks spread apart. With the patient installed in this way, care is facilitated by more anatomical technique. Using this installation it is possible to close the fistula by simple suture (Chassar-Moir) or with interposition of the labium majus (Martius autoplasty).

Effects of pulsed dye laser lithotripsy on tissues. Experimental study in the canine ureter

This experimental study demonstrates the absence of irreversible tissue damage after lithotripsy with a pulsed dye laser. The absence of thermal damage with this laser is due to the beam divergence capacity at the end of the fiber and to the short pulse, which generates very low thermal effect. These results as a whole confirm the safety of the pulsed dye laser and indicate that it can be used for clinical treatments in humans.

[Renal angiomyolipoma. Diagnostic value of magnetic resonance imaging]

Owing to the wider use of ultrasonography, renal angiomyolipoma is now diagnosed with increasing frequency. Within a few months, 10 female patients were explored by ultrasounds, computerized tomography and nuclear magnetic resonance (Magniscan 5,000, 0.5 Tesla). At ultrasonography the lesion was hyperechogenic in 9 cases and heterogenic in 1 case. At computerized tomography 7 patients had a strongly hypodense lesion and 3 had a lesion of slightly positive density. At magnetic resonance imaging the lesion produced a characteristically loud signal similar to that of fatty tissues. In practice, ultrasonography and computerized tomography combined provide the diagnosis in most cases. In case of doubt, especially since the tumour may be small and asymptomatic and the lesions multiple and/or bilateral, magnetic resonance imaging with its fat-like loud signal confirms the diagnosis and leads to partial resection. When no complications are present, it may even suggest that surgery is unnecessary.

[Behavioral disorders secondary to benzodiazepine therapy]

This report adds three cases to those previously published of paradoxical reactions to benzodiazepines. The clinical syndrome, more or less complete, is fairly stereotyped, with behavioural disorders, tendency to feelings of hostility and aggressiveness and total anterograde amnesia. Personal and environmental factors seem to play a prominent role in its development. The classical contra-indication of benzodiazepines following such reactions is discussed, and the hypothesis that mamillary-thalamic benzodiazepine receptors play a part in their genesis is envisaged.

[Evaluation of the number of patients likely to require surgical treatment of hepatic metastases. Based on a series of 180 colorectal cancers]

The spontaneous prognosis of patients with hepatic metastases from colo-rectal cancer is poor in the short term: less than 10 p. cent will be alive after 2 years. Over recent years, several teams have obtained encouraging results after surgical resection of hepatic metastases. The aim of the present study was to evaluate the number of patients likely to require resection of hepatic metastases in a serie of 180 cases of colo-rectal cancer. 57 patients (30 p. cent) already had hepatic metastases at the time of the gastro-intestinal resection and only 3 underwent a simultaneous metastasectomy. In the other cases, the extent of the disease or the general condition of the patients contra-indicated a 2-stage resection. Among the 126 patients free of metastases at the time of the operation, 40 p. cent would have been excluded from hepatic resection in the event of secondary development of metastases because of the general clinical state. 75 patients were suitable for post-operative surveillance of hepatic metastases. We calculated that 20 of them might develop a hepatic metastasis without local recurrence of the colo-rectal cancer in the 2 years following the colonic resection, although of course we were unable to predict the type of metastasis or its accessibility to surgery. These figures may be useful as a guide to the development of a surveillance strategy.

[Ultrasonic inspection of the permeability of surgical portacaval shunts]

Ultrasonography was used to evaluate the patency of portocaval shunts in 9 patients: 2 with spleno-renal anastomosis, 4 with portocaval truncular anastomosis, 2 with mesenteric-caval shunt and 1 with atypical shunt. The shunt count be demonstrated in 7 of these 9 patients. Angiography was performed in 6 cases and confirmed the results of ultrasonography--a finding favourable to the latter method and in agreement with those of other authors. However, the usefulness of ultrasonography varies according to the type of shunt created, as shown by our own experience and by published reports: 70% of portocaval truncular shunts, 65% of spleno-renal shunts and 46% of mesenteric-caval shunts are demonstrable by ultrasounds, these variations being due to differences in location and accessibility to the ultrasonic examination. It ultrasonography fails to display the anastomosis, it may provide indirect signs of patency. In addition to being harmless and relatively inexpensive, ultrasonography is a valuable method for evaluating portocaval shunts. It can easily be repeated and its results need not be confirmed by angiography.

[Is thallium scintigraphy of value in the preoperative localization of pathologic parathyroid glands?]

15 patients with primary hyperparathyroidism were studied by Thallium scintigraphy in order to localize, preoperatively, the parathyroid adenoma(s). Compared with the operative findings, the scintigrams provided correct information in 10 cases and false information in 5 cases. These results are therefore inferior to those previously reported in the literature.

[Voluminous exogastric myoid tumor. Contribution of echotomography and x-ray computed tomography]

We described a case of voluminous exogastric leiomyoblastoma revealed by abdominal pain and clinical mass. Ultrasonography showed a mixed mass, with both solid and liquid components, without determining specifically the organ of origin. CT body examination showed an intense hypervascularization, associated with cystic components. Laparotomy with tumor excision was done without any metastases. Such US and CT aspects can lead to the exact diagnostic, if they prove the gastric origin of the mass. Otherwise, the discussion is between pancreatic or epiploic tumors.

[Ureteral stenosis after treatment of uterine cervical cancer: post-radiotherapy fibrosis or neoplastic recurrence?]

Ureteral stricture occurring after radio surgical treatment of uterine cervix cancer does not necessarily express a recurrence of malignancy. The same radiological features may be seen after radiotherapy and then has an incomparably better prognosis. Having in mind the natural history of cancer of cervix we analysed 28 cases of such a tumor, treatment by radiotherapy and surgery. This study led us to defend several discriminating criteria between these 2 conditions. A diagnostic strategy is suggested.

[Prevention of bacterial grafts on revascularization of the arteries of the leg. Apropos of 18 infections in 1000 surgically treated cases]

The incidence of vascular and prosthetic infections was compared during two successive periods, each involving approximately 500 surgical acts, a strict protocol of infection prophylaxis being applied during the second period: infection was reduced from 2.7 to 1.5 p. cent (2.3 to 0.5 p. cent after aorto-ilio-femoral grafts). Failure to respond to treatment during the second period occurred under two circumstances: when prophylaxis was insufficient to cover emergency procedures, and when antibiotic therapy was directed against staphylococci only, resulting in persistence of a high level of infections due to Gram-negative bacilli. Analysis of different epidemiological factors, including the germs, the patient, the treating team, and the prosthesis, led to the adoption of numerous specific measures. Their respect implies collective awareness, assisted by analysis of weekly complications and annual results with the involvement of the total team. Prophylactic antibiotic therapy should be of short duration, the antibiotics being selected in reference to the sensitivity of the germs included in the hospital statistics, and of the antibiotic policy which reserves recently developed molecules for curative purposes.

[Primary hypoglycemic mesenchymatous tumor of the pleura (Doege-Potter's syndrome) : a case report]

A patient had been operated 4 years ago for a hypoglycemic tumor of the pleura. The lesion could be separated from the lung, and histological examination demonstrated an undifferentiated markedly cellular appearance of the tumor. Ultrastructural features were not in favor of a mesothelial tumor. Prognosis in such cases depends upon the histological type of tumor present, but remains uncertain, particularly in some apparently morphologically benign forms. Th most valid hypothesis to explain the genesis of this syndrome involves the role played by the non-suppressible insulin-like activity of a substance secreted by the tumor. This is a glycoprotein, molecular weight 90 000, which has recently been isolated, and which could play an important role as a non-suppressible insulin-like protein.

[Splenic abscess. 3 cases (author's transl)]

The authors report three cases of splenic abscess. The condition developed twice during a salmonella infection associated in one case with sickle cell disease. In two patients, the spleen was the site of a suppurated infarction. One patient died shortly after operation. Study of the 79 cases of splenic abscess treated surgically published since 1960 reveals a mortality of 16%. This rare condition is seen essentially during typhoid and septicaemias (endocarditis). Such pathology in also now seen in drug addicts. The diagnosis and, hence, the prognosis should be improved by the use of echography which seems to be the most reliable investigation before peritonitis by rupture which remains a complication associated with a heavy mortality.