Magnetic resonance quantification of skeletal muscle lipid infiltration in a humanized mouse model of Duchenne muscular dystrophy

Rodent models of Duchenne muscular dystrophy (DMD) often do not recapitulate the severity of muscle wasting and resultant fibro-fatty infiltration observed in DMD patients. Having recently documented severe muscle wasting and fatty deposition in two preclinical models of muscular dystrophy (Dysferlin-null and mdx mice) through apolipoprotein E (ApoE) gene deletion without and with cholesterol-, triglyceride-rich Western diet supplementation, we sought to determine whether magnetic resonance imaging and spectroscopy (MRI and MRS, respectively) could be used to detect, characterize, and compare lipid deposition in mdx-ApoE knockout with mdx mice in a diet-dependent manner. MRI revealed that both mdx and mdx-ApoE mice exhibited elevated proton relaxation time constants (T2 ) in their lower hindlimbs irrespective of diet, indicating both chronic muscle damage and fatty tissue deposition. The mdx-ApoE mice on a Western diet (mdx-ApoEW ) presented with greatest fatty tissue infiltration in the posterior compartment of the hindlimb compared with other groups, as detected by MRI/MRS. High-resolution magic angle spinning confirmed elevated lipid deposition in the posterior compartments of mdx-ApoEW mice in vivo and ex vivo, respectively. In conclusion, the mdx-ApoEW model recapitulates some of the extreme fatty tissue deposition observed clinically in DMD muscle but typically absent in mdx mice. This preclinical model will help facilitate the development of new imaging modalities directly relevant to the image contrast generated in DMD, and help to refine MR-based biomarkers and their relationship to tissue structure and disease progression.

[Evaluation of accuracy of three assays for human papillomavirus detection and typing: Hybrid Capture 2, HPV Consensus kit and Amplicor HPV]

BACKGROUND

Detection of high-risk human papillomavirus has proved its usefulness in complement of abnormal cervical scrape result. The Hybrid Capture 2 (HC2, Digene) test has proven its efficiency. We have compared this test with HPV Consensus kit (HPVC, Argène) and Amplicor HPV test (AHPV, RocheDiagnostics) on a panel of 88 samples with low HC2 ratios or discordant results between HC2 and cervical scrape.

MATERIAL AND METHODS

Cervical samples were tested in parallel by the three methods using a nested amplification of L1 region as reference.

RESULTS

Eighty-six samples were suitable for analysis. Results of HC2 and AHPV tests were closely related. The use of a "generic" probe in the HPVC test was responsible for undetermined results, which were not clinically relevant.

CONCLUSION

Despite the low viral load of the samples chosen, the hybridization (HC2) and PCR (AHPV or HPVC) methods gave comparable results, with false positive and false negative results for all tests, but a 75% concordance and a high sensibility to detect HPV infection. However, a complementary study on a larger population with ASCUS diagnosis and biopsy under colposcopy would be necessary to valid these assays for a clinical indication.

[Hybrid Capture 2 vs HPV Consensus kit: comparison of 2 assays for human papillomavirus detection and typing]

BACKGROUND

Many laboratories use the DNA Hybrid Capture 2 HPV-high risk assay (Digene) to detect and type oncogenic HPV. The aim of this work was to compare this assay with a new HPV genotyping assay: HPV Consensus kit (Argène). Actually, this assay is not commercially available.

MATERIALS AND METHODS

Ninety-four cervical samples were tested with both the routine assay Hybrid Capture 2 and the HPV Consensus kit. Discordant results were analysed by amplification with a nested PCR and sequencing of amplified products.

RESULTS

Only 81 results could be analysed concerning the oncogenic risk. The overall concordance was 92,6%. But we find 13 "generic" results with the HPV Consensus kit, the generic probe including high risk and low risk genotypes.

CONCLUSION

HPV Consensus kit results showed a better detection sensitivity for this assay than Hybrid Capture 2 assay. Nevertheless, "generic" results give no information about the oncogenic risk of the HPV detected in a sample.

[Screening and sequence analysis of the adult stage-specific gene of Trichinella spiralis]

OBJECTIVE

To obtain the sequence of the adult stage-specific gene of Trichinella spiralis.

METHODS

An adult T. spiralis cDNA library was screened using an adult T. spiralis stage-specific probe. The gene sequence was analyzed by DNAstar software and GenBank database.

RESULTS

A cDNA clone of 1,629 bp was obtained by screening the library with an adult stage-specific probe. The clone contained one open reading frame composed of 1,464 bp encoding 487 amino acids. GenBank searching revealed that no identical cDNA was found. Two zinc fingers located at the positions within amino acids 207-270. Some possible antigen epitopes were predicted within the amino acids 52-64, 108-116, 137-163 and 226-260.

CONCLUSION

A novel stage-specific gene of adult T. spiralis encoding the protein containing certain predicted antigen epitopes was obtained.

[Suicide and attempted suicide in the armed forces in 1998]

Little data exists concerning suicides and attempted suicides on professional duty. Now that the French Army is becoming professional, it is necessary to describe methods of self-destruction, in order to facilitate preventive measures.

METHODS

The French Army operated a surveillance system to record all instances of suicide and attempted suicide. Under this surveillance system, all suicidal acts and attempts must be reported through an anonymous standard form completed by a military physician. This form records demographic data, the circumstances and known motives. For the epidemiological analysis, we used the chi square test and the Student test. A method of indirect standardization was employed to enable comparisons between military suicides and those within the general French population in 1996. We chose a risk of error of 5%.

RESULTS

During the course of 1998, 145 forms were gathered for professional armed forces. Of these, 40 were recorded as actual suicides and 105 as attempted suicides. The suicide rate corresponded to 14p 100,000. Suicides were limited exclusively to males, the average age at death was 36. Comparisons with the French male population at large (using the indirect method of standardization) showed a standardized mortality rate of 0.43 (p > 0.05). Methods of self-destruction employed were mostly hanging and using firearms. Attempted suicide rate was 31.5 p 100,000, with a relatively even balance between males and females. The average age was 30. Methods of self-destruction employed were mostly drug ingestion and laceration. Difficulties with personal relationships were the principal motive recorded, whilst instances of psychiatric diseases were rare. Previous suicide attempts were known in 21% of recorded suicide attempts in 1998 and in 10% of actual suicide. There was no suicidal act during or linked to an outside army operation. The ratio suicide-attempted suicide was 0.38.

DISCUSSION

The fact that the rate of suicide in the French Army is lower than the national average could be explained by the medical criteria used to select army personnel on active duty. These results should be interpreted with caution: our data only covers a single year. Moreover, there is a certain bias in the surveillance system used. Measures in the French Army to prevent suicide are based on a significant medical component within units, particularly during operational tours where there is sometimes a psychiatrist. Although the military physician is constrained by professional secrecy, he must execute his duty as an advisor to the commanding officer to signal human factors that need to be taken into account. Responsibility for knowing men and living conditions lies with the commanding officer. Epidemiological surveillance is a key element of analyzing the risks of suicidal. Its contributing role should be regularly reevaluated.

[Cost-benefit ratio of tick-borne encephalitis vaccination of French troops based in Kosovo]

BACKGROUND

French military troops based in Kosovo are exposed to Tick-Borne Encephalitis (TBE) biorisk. An efficacious vaccine is available to prevent this disease, burdened by high morbidity and mortality. The epidemiologic features of TBE in Kosovo are unprecise. To help the French Department of Defense to make a decision about immunization against TBE, we performed a cost-benefit analysis.

METHODS

By a Bayes'analysis decision, we have estimated the net benefits for a three-injection vaccine program versus absence of vaccination, for all French military troops based in Kosovo. Time expectancy was 4 years. Through the review of several medical reports, we have estimated the useful parameters for this study: morbidity incidence rate, mortality rate, sequelae rate, efficacy vaccine and side effects. We have chosen as initial hypothesis a sero-conversion rate of 1,080 per 100,000 men-by-year. Human life was valorized in francs, by calculating the allowance paid by Department of Defense to the family in case of death or for sequelae.

RESULTS

Net benefits arised to 2.17 millions of francs. The vaccine program cost was 25.0 millions of francs. 140 cases of encephalitis viruses were saved by vaccination. Nevertheless a sensibility analysis has shown that results are well reliable with TBE incidence rate.

CONCLUSION

The break even point being close to the incidence rate of the initial assumption, the decision to vaccine all French military troops depends at the same time on a better knowledge of the incidence of the disease in Kosovo, but also of the number of potentially avoided cases of tick-borne encephalitis and of the programs of vaccination concerning this disease of the other countries forming the United Nations Organization forces.

[Acute acoustic trauma in military personnel. Evaluation of 1 year epidemiologic surveillance]

OBJECTIVES

Acute acoustic trauma (AAT) refers to damage to sensitive cochlear structures caused by excessive exposure to impulse noise. The aim of this study was to 1) assess the incidence of ATT in French soldiers and 2) to clarify the circumstances under which AAT occurs.

PATIENTS AND METHODS

We carried out a prospective study of AAT events reported to medical officers in 1998.

RESULTS

The incidence of AAT was 156 per 100,000 person-years (150-161). It was higher in conscripts and in soldiers aged under 31 years. Fifty-seven percent were wearing hearing protectors when the accident took place.

CONCLUSION

According to these results, specific preventive programs were planned and should be assessed by epidemiological surveillance of exposed populations.

Decision-making in the colposcopy clinic--a critical analysis

OBJECTIVE

To consider the omission of several diagnostic steps from the management of patients with high-grade squamous intraepithelial lesion (SIL) by analyzing the role of each step on the choice of treatment.

STUDY DESIGN

Each diagnostic procedure was correlated to the treatment and outcome in 87 women with high-grade SIL. Treatments considered were large loop excision of the transformation zone (LLETZ) cold knife conization, and CO2 laser vaporization.

RESULTS

Unsatisfactory colposcopy (P< or =0.01) and positive endocervical curettage (ECC) specimen (P< or =0.01) were essential for choice of treatment. CIN2 diagnoses of the preoperative cervical biopsy were rediagnosed as CIN3 based on the surgical specimen in 57% of the cases. The margins of 33 and 23% of surgical specimens removed by LLETZ or knife conization, respectively, displayed CIN involvement. Forty and 47% of these patients, respectively, later developed recurrent CIN.

CONCLUSIONS

Omission of colposcopy and ECC could have resulted in sub-optimal treatment in many cases. Excision by LLETZ or knife conization is recommended for cases of CIN2 and CIN3. Follow up is imperative for patients with involvement of the margins.

[Malaria epidemic during a military-humanitarian mission in Africa]

A malaria epidemic broke out among French servicemen during a humanitarian military mission carried out in Central Africa in 1996. The purpose of this study was to determine compliance with drug prophylaxis for malaria by measuring blood levels of antimalarial drugs (combination treatment using chloroquine-proguanil or treatment with doxycycline) as well as to assess the conditions of vector control. The incidence density rate of malaria over a 60-day period was 3.1 cases per month per 100 men. Only reinforcement troops were affected. The risk of developing malaria was 5 times higher among new arrivals than in servicemen who had been in the zone for several months (95% CI relative risk = [2.9-7.8]). Type of prophylactic treatment had no effect on the incidence density rate. Study data showed that 40.2% of those treated for malaria were not in compliance with prophylactic treatment at the time of the malarial attack and that those who were in compliance with prophylaxis, i.e. the remaining 59.8%, presented a strain of plasmodium that was resistant to the prophylactic drugs at doses used. Findings also indicated the epidemic occurred mainly because operating conditions prevented implementation of proper vectorial control. The risk of epidemic could probably have been reduced by improving compliance with prophylactic treatment and changing standard vectorial control techniques, e.g. by using insecticide-treated uniforms.

Recombinant human interferon-beta for condylomata acuminata: a randomized, double-blind, placebo-controlled study of intralesional therapy

To assess the efficacy of a novel glycosylated mammalian cell derived recombinant human interferon-beta (r-hIFN-beta-1a) in the intralesional treatment of genital condylomata acuminata. The study was randomized, double-blind and placebo-controlled. Patients (n=60) with up to 8 distinct condylomata acuminata were randomized to receive either one million international units (IU) of r-hIFN-beta-1a or placebo intralesionally into each lesion, 3 times a week, for a total of 9 occasions. Biopsies were taken from each patient before enrolment to allow human papillomavirus (HPV) testing, and patients were tested for the development of anti-IFN-beta antibodies. Efficacy was assessed by measuring the complete response rate 3 months after treatment. The complete response rate was not significantly better with r-hIFN-beta-1a than with placebo. However, after 3 months, 73.3% of patients treated with r-hIFN-beta-1a had experienced at least a partial response to treatment, compared with 33.3% of placebo-treated patients. At 19 days and 6 weeks, r-hIFN-beta-1a produced a significantly larger reduction in the area of condylomata. Lesions with detectable HPV6 or 11 showed a trend towards a better response rate to treatment with r-hIFN-beta-1a than lesions where no HPV DNA was detected. The treatment was well tolerated. In the 5 patients who developed non-neutralizing anti-IFN-beta antibodies, therapeutic efficacy was not compromised. Intralesional r-hIFN-beta-1a was effective in the reduction of the size of genital condylomata acuminata.

[Evaluation of the completeness of the epidemiological surveillance systems for malaria by the Capture-recapture system in the French armies in l994]

The Capture-recapture method has been utilized to evaluate the annual incidence of malaria in the French armies in 1994 on the basis of the incidence derived from two regulatory systems, passive and exhaustive, of epidemiological surveillance: the Recueil et l'Exploitation des Données Epidémiologiques des Armées (REDEA) and the Surveillance Epidémiologique du Paladisme (SESP) system. Cases of malaria found by REDEA and SESP in 1994 rose to 480 and 424 respectively. Two hundred and thirty-eight cases were found by both systems. After validating the conditions for the application of the Capture-recapture method (in particular, having verified that the results from REDEA and SESP were probably independent), its utilization allowed us to evaluate the incidence of malaria in the French army in 1994 at 854 cases. The calculated exhaustivity values for REDEA and SESP were 56.2 and 49.6% respectively; 22% of cases were missed by both systems. The exhaustivity values of SESP and REDEA estimated in our study were comparable to those obtained by the Capture-recapture method applied in another legal inquiry into the passive and exhaustive epidemiological surveillance of meningitis and meningococcosis in France in 1989 and 1990. These results show that it is difficult to evaluate the epidemiological importance of a sickness on the results of passive and exhaustive surveillance alone. In 1995, a new system of surveillance was established in the army: a better conducted and more motivated retro-informative system, linked to a better education of medical officers in epidemiological surveillance permitted an improvement in the completeness of the results in the armies.

Diagnostic pitfalls of ultrasonographic uterine screening in women treated with tamoxifen

Recent reports of an association between tamoxifen treatment for breast cancer and endometrial pathology prompted a screening program for women receiving tamoxifen. Twenty-two women were examined; 15 were asymptomatic, and 7 were referred because of abnormal vaginal bleeding. All underwent vaginal ultrasonography followed by endometrial sampling. The sonographic studies showed endometrial abnormalities in all 22 women--typically, irregular thickening of the endometrium. Some had cystic formations, and three had fluid in the endometrial cavity. No pathology or inadequate material was found in the endometrial samples from the 15 asymptomatic women. Endometrial polyps were suspected sonographically and removed from two of the five women with vaginal bleeding. The discrepancy between the sonographic findings and histology in the asymptomatic women could have been due to stromal edema from tamoxifen treatment. Abnormal ultrasonographic findings in asymptomatic women treated with tamoxifen probably represent insignificant changes in the endometrial architecture and not a true abnormality. The need for routine endometrial sampling or hysteroscopy in every case is therefore questionable.

Polyclonal anti-idazoxan antibodies: characterization and purification

Amino-idazoxan coupled to hemocyanine was used to raise anti-idazoxan antibodies in the rabbit. The antibodies were affinity purified with an amino-idazoxan affinity column. Binding studies with [3H]idazoxan showed a dissociation constant of 2.2 +/- 1.4 nM. The specificity spectrum of these antibodies indicates that the imidazoline part of idazoxan is more important for recognition than the benzodioxan ring as imidazoline substances (clonidine, cirazoline) are powerful competitors of [3H]idazoxan binding on the antibodies. Catecholamines or imidazoles were unable to displace [3H]idazoxan from the antibodies. These anti-idazoxan antibodies present specificity similarities with the imidazoline receptor as did our previously obtained anti-clonidine antibodies. Affinity-purified antibodies represent useful tools for studying the imidazoline receptors particularly with an anti-idiotypic approach.

Intramuscular beta-interferon treatment for severe vulvar vestibulitis

Seven patients with vulvar vestibulitis associated with human papillomavirus (HPV) infection were treated with intramuscular (IM) injections of human beta-interferon. The IM route was chosen to avoid painful intralesional injections. Complete remission of symptoms was achieved in three patients who received 45 x 10(6) IU of beta-interferon; they remained asymptomatic for a duration of 6-18 months following treatment. Of the four patients who received only 30 x 10(6) IU, two had complete remission of dyspareunia, but in one it recurred after 18 months; one had some relief; and one did not respond. Two patients who did not show complete remission of the disease and the one with recurrence subsequently underwent perineoplasty. The IM treatment was well tolerated and resulted in a satisfactory response in a selected group of patients. There is evidence to suggest that a total dose of 45 x 10(6) IU is preferable to a dose of 30 x 10(6).

Treatment of a patient with vulvar vestibulitis by intramuscular interferon beta; a case report

A patient with severe dyspareunia caused by vulvar vestibulitis, associated with human papillomavirus infection, was treated by intramuscular interferon beta. The treatment was well tolerated and no side effects were reported. A complete resolution of the vestibulitis was noticed 2 months later. No recurrence was noted during a year of follow-up.

[The vulvar clinic]

Until recently, vulvar diseases have not been given sufficient attention by gynecologists. This might be attributable to the timidity of patients with chronic vulvar pruritus, tumor or dyspareunia, which delays diagnosis and treatment. In addition, the nomenclature of vulvar disease was complicated by having been adapted from various dermatological disorders. Only following the establishment of the International Society for the Study of Vulvar Disease (ISSVD) and of specialized clinics, has awareness increased and more attention is now being paid to vulvar disorders. The findings in 242 patients seen during the first year of operation of a vulvar clinic were analyzed. The most common presenting symptom was chronic vulvar pruritus. Non-neoplastic epithelial disorder (dystrophy) was the most common histological finding in the 79 women with pruritus, while 2 were diagnosed as having vulvar intraepithelial neoplasia, and 1 had basal cell carcinoma. In contrast, vulvar vestibulitis was the main diagnosis in 34 women referred for vulvar pain (vulvodynia). Vulvodynia was also associated with other inflammatory processes and with human papilloma virus (HPV) lesions (condylomata). The primary finding in 26 women referred for evaluation of a vulvar "tumor" was epidermal cyst. In only 55 (75.5%) of the 73 referred for suspected HPV lesions was the histologic diagnosis confirmatory. In addition, a few vulvar ulcers were associated with HPV. A single treatment with carbon dioxide laser eradicated the HPV lesions in 93% of the cases. The vulvar clinic contributes to the ambulatory gynecological service by concentrating diagnosis and treatment in a single specialized unit and increases understanding of, and interest in vulvar disease.

Outpatient diagnostic endometrial aspiration curettage with a new aspiration curette

During a period of 2 years (1981-1982), 226 outpatient endometrial aspiration curettages (EACs) were performed with a new aspiration curette that had been developed by the authors. All patients had risk for general anesthesia. From 17 of them, endometrial polyps were removed by the EAC. Endometrial carcinoma was diagnosed in eight others, adenomatous hyperplasia in four, and cystic hyperplasia in two women. The main advantage of the new curette is the ability to aspirate endometrial polyps through its modified opening.

Removal of completely perforating IUDs by explorative laparotomy

Nine patients with completely perforating intrauterine contraceptive devices are presented. In all cases, the device was removed by explorative laparotomy. In eight out of the nine women, the device was found to be embedded in the omentum or vesical peritoneal plica. The advantages of explorative laparotomy over laparoscopy or colpotomy are emphasized.

Inhibitors of urinary stone formation in 40 recurrent stone formers

The excretion of four inhibitors of urinary stone formation (zinc, magnesium, citrates and glycosaminoglycans (GAG) was studied in 20 normal controls and 40 recurrent calcium stone formers who were placed on a fixed diet restricted in calcium, oxalates and purines. We were unable to show any abnormality in the excretion of Zn, Mg or GAG. In 11 patients, a low level of urinary citrate was a significant feature that was associated in most cases with a urinary pH value above 6. Citrate concentration (per litre) and output (per 24 h) were found to be lower than in the controls in 19 and 33% respectively of the determinations. The overall ratio of average urinary citrate concentration in patients and controls was 0.56, a figure in agreement with previous data.

Ambulatory removal of cervical polyps under colposcopy

Hospitalization, polypectomy, and D&C under general anesthesia, are the usual way to treat a cervical polyp. This article describes a simple, ambulatory way of performing polypectomy under colposcopic vision, with no need for hospitalization and general anesthesia. The paper summarizes our experience with this method in 96 patients. Our conclusion is that this simple procedure spares the patient general anesthesia, D&C, and unnecessary hospitalization with attendant expense.

[Neonatal screening for duchenne myopathy by serum elevation of creatine phosphokinase activity. 5 years experience]

The systematic seek of an increased activity of the SCK among all newborns has permitted the detection of the Duchenne-type muscular dystrophy in the "Rhone-alpes" area. By the survey of 40,000 births during 5 years and the detection of 16 Duchenne-type muscular dystrophies the authors estimate the incidence of DMD at 1/6500 living new born boys. The number of false positives (1,5 p. 1000) is little and, up to now, no false negative has been recorded. A few boys and girls keep and increased activity of the SCK, and 3 boys hae a Becker-type muscular dystrophy.

[Assessment of the renal consequences as related to operative technique in surgery for 190 staghorn or calyceal calculi. Comparative value of renal scintigraphy and intravenous urography (author's transl)]

The authors have studied 86 patients with staghorn calculi who underwent preoperative quantitative renal scintigraphy. 50 of them (63 kidneys) had one or two follow-up scans between 1 and 9 years after the operation. These scintigraphic data were compared with those of I.V.U. These 50 patients had undergone surgery on 60 kidneys (12 pyelotomies only, 26 pyelotomies associated with limited nephrotomies, 18 extended nephrotomies and finally 4 bi-value nephrotomies). In 46 of these patients, the urine became definitively sterile and there was no recurrence of lithiasis in any of them. These quite exceptional conditions were such that it is possible to bear in mind only the operative technique in assessing the possible harmful consequences of each type of operation. The authors clearly show that the threat to function of the kidney which has been operated upon is more threatened when there has been a nephrotomy and when such a nephrotomy has been more extensive. A limited nephrotomy is associated with a mean loss of (% of renal function. Extended nephrotomies or more than 3 cm result in a loss of function of approximately 22%. Large bi-value nephrotomies result in a 36% loss of function. Simultaneous study of scintigraphic scans and I.V.U. revealed that a loss of 1 cm in height of the renal parenchyma corresponds to a functional loss of 10% as determined by scintigraphy. Of basic importance is the fact that the impairment caused by nephrotomies remains stable and does not worsen with the passage of time.

[Therapeutic trials in inoperable carcinoma of the bladder (author's transl)]

The authors report the preliminary results of attempts at treatment using radiotherapy and chemotherapy for inoperable carcinoma of the bladder. Chemotherapy alone (cis diamine dichloropalatinum : CDDP) used twice for metastases gave 1 regression of more than 50 % and 1 failure, used twice for non-irradiated pelvic tumours gave 1 regression of more than 50 % and finally was associated with no improvement in 7 patients already irradiated. Chemotherapy (CDDP) associated with a series of flash doses of radiotherapy was used in 6 cases and gave one regression of more than 50 % and one of less than 50 %. Bleomycin in continuous infusion associated with flash radiotherapy was used in 3 cases and gave a regression of more than 50 % of pelvic tumours in two. These poor though not completely nil results have lead the authors to develop a cooperative treatment programme involving the urologist, radiotherapist and chemotherapist.

[The treatment of stress incontinence in women by aponeurotic "supporting" of the neck of the bladder. A new improved technique (author's transl)]

The authors describe a number of new technical details concerning surgery for stress incontinence in the woman using a sub-cervical strip. This involves the taking of a free aponeurotic strip from the upper lip of a Pfannensteil incision (which eliminates all possibility of incisional hernia), extensive pre-vesico-cervico-urethral dissection which is particularly important during reoperation (which allows the neck to rise up into its "normal" position in a patient placed in the Trendelenburg position), preparation of the sub- and latero-cervical course via a vaginal approach (avoiding tearing of the bladder and malposition of the strip), accurate placing along a straight line of the two "legs" of the U-shape given to the strip under visual control, without any tension (which avoids dysuria and should be adequate to ensure continence during stress) and finally attachments of the free ends of the aponeurotic strip to the medial end of the ligaments of Cooper using non-absorbable sutures (which leaves the strip at the desired length). Results : nine patients who had never undergone previous surgery, with nine cures ; ten patients operated upon after the failure of previous surgery for stress incontinence (8 successes and 2 failures including one reoperation with success using the same technique) ; finally, five patients operated upon for stress incontinence occurring after pelvic surgery of another type : 3 successes and 2 imperfect results. The authors briefly mention the 21 failures seen in a series of 26 cases of uplifting of the neck using a strip of skin and the 18 failures in a series of 30 reoperations for the treatment of stress incontinence in which there was no cervico-urethrolysis prior to passage of the strip.

[Cutaneous urine shunts in adults (author's transl)]

The authors review 123 cases of cutaneous urine shunts in adults. - 93 cutaneous ureterostomies in 63 patients (58 malignant and 5 tuberculous lesions). There were 5 postoperative deaths (8%) and in the 36 operated cases followed-up for varying periods there was 1 death only from progressive renal insufficiency (2.7%), 10 minor incidents (27.8%) and 2 cases with kidney stones (5.5%). Not one of these patients had to be operated on again - 3 cutaneous uretero-ureterostomies with 2 excellent results and necrosis of the foot of the Y in the other case. - 45 transintestinal cutaneous ureterostomies (38 ileal loops and 7 colon grafts) for fistula of the lower urinary tract (2 cases), malignant tumors (35 cases), tuberculosis (1 case), bladder extrophia (1 case), neurological bladder (6 cases). There were 4 early postoperative deaths (8.9%) and 5 severe complications (2 eviscerations, 2 occlusions, 1 digestive tract hemorrhage). Of the 37 operated cases followed-up for varying periods, 5 (13.5%) had diminished renal function, 23 (62%) had late complications requiring further operations in 17 cases (45.9%). These complications were 7 cases of stenosis of the ureter, 1 case of fistual of the ureter, 1 ileal fistula, 4 cases of stenosis of the graft opening, 3 prolapses of the graft, 1 skin lesion, 5 kidney stones and 1 case in which reflux was poorly tolerated. - 12 transprosthetic cutaneous ureterostomies with only 2 good results. No cutaneous shunt operation is exempt from complication. Transprosthetic cutaneous ureterostomies are probably the least affected. Direct cutaneous ureterostomies are statistically better tolerated than transintestinal cutaneous ureterostomies, which appear to have the major inconvenience of deteriorating at a later stage, requiring repeated further operations.

[Course of superficial malignant tumors of the bladder. Apropos of 135 cases]

After recalling the difficulty of comparing the various series published in the literature. in the absence of common histological criteria. the authors review the records of patients with a class III or IV carcinoma of the bladder. strictly confined to the musoca, whether or not the basal membrane was damaged (stage O or A), with the exclusion of all cases with histological invasion of the muscularis and any other clinical or radiological signs of deep infiltration: 135 records with a follow-up of at least 6 months. This study led to the following findings: - One third of the tumours progressed to deep infiltration and/or metastases. - This unfavourable course occurred. in almost 3/4 of cases. during the 2 years following the clinical presentation of the tumour. - Such a grave course may develop for tumours not affecting the basal membrane without it having always been possible to define the stage of infiltration of the chorion. - A metastasis may develop while the tumour remains superificial. - 5 out of these 135 patients developed 2 or more extra-urological carcinomas. - Two thirds of these superifical tumours did not invade the muscularis during the period of observation which in 41 cases exceeded 6 years. - The difficulty lies in detecting which superificial malignant tumours of the bladder will not recur. which will recur superficially (where preservation of the bladder is automatic) and which will recur with infiltration and/or metastases. where an aggressive therapeutic attitude should be adopted before any infiltration or diffusion of the tumour manifests itself. - Tumours which did not recur were unifocal. - All multifocal tumours treated conservatively recurred.

[Results of radical surgery for renal cancer in adults]

For thirteen years, between 1963 and 1976, 120/139 patients with renal cancer were operated. 45 were stage I, 20 were stage II, 45 were stage III and 12 were stage IV (Robson's classification). Of the 45 stage III cancers, 13 had lymphatic invasion and 37 had venous invasion ranging from microscopic stages to invasion of the inferior vena cava. Treatment included: preoperative teleirradiation with cobalt most often a single dose of 500 rads on the day before the operation. Wide excision with primary ligation of the vascular pedicle and node dissection via a lumbar abdominal transperitoneal route remaining the minimum strictly necessary. Sequential monthly chemotherapy over two years of Vincristine and CCNU (chloroethyl cyclo hexylnitroso urea). Postoperative mortality was considerable (14%) but involved patients with advanced cancers, poor general condition (o% stage I, 10% stage II, 22% stage III and 40% stage IV). The long range survival remains excellent in spite of the postoperative losses: 65 p. cent 5 years all stages. However, stage determines the prognosis: 85 p. cent 5 year survival stage I and II and 53 p. cent 5 year survival stage III. Severe affection of the general state of the patient carries a very poor prognosis. Fever does not indicate a worse value except in stage III tumors. In stages I and II it can have value in the paraneoplastic syndrome (terme non familier). The authors, uncertain of the efficacity of preoperative radiotherapy and postoperative chemotherapy, concluded that wide excision with node dissection is the proper fundamental treatment of renal cancer in the adult.

[The urethra in congenital aplasia of the abdominal wall. Concerning 15 cases (author's transl)]

The authors have collected in 13 years, 15 cases of congenital aplasia of the abdominal wall. All of the patients had involvement of the urinary apparatus of varying degree of severity, megalo-ureter, megabladder and dilatation of the posterior urethra being the most constant lesions. Twelve patients with renal failure, benefited from reparatory surgery of the excretory pathway. Eleven patients had complete or incomplete retention: in 5 cases there was a urethral valve. In 6 cases the megalo-urethra was apparently idiopathic. In all of these cases, endoscopic treatment was carried out, constituted either of resection of valves, or internal urethro-sphincterotomy using a cutting electrode: 9 times, the result obtained was excellent. One patient was improved; in one case the result could not be assessed. For the authors, obstructive urethral pathology is a frequently unrecognized or badly understood fact. It is accessible to endoscopic treatment, which must precede or accompany correction of the ureteral abnormalities.