Chronic Inflammation and Radiation-Induced Cystitis: Molecular Background and Therapeutic Perspectives

Radiation cystitis is a potential complication following the therapeutic irradiation of pelvic cancers. Its clinical management remains unclear, and few preclinical data are available on its underlying pathophysiology. The therapeutic strategy is difficult to establish because few prospective and randomized trials are available. In this review, we report on the clinical presentation and pathophysiology of radiation cystitis. Then we discuss potential therapeutic approaches, with a focus on the immunopathological processes underlying the onset of radiation cystitis, including the fibrotic process. Potential therapeutic avenues for therapeutic modulation will be highlighted, with a focus on the interaction between mesenchymal stromal cells and macrophages for the prevention and treatment of radiation cystitis.

Malignant melanoma revealed by testicular metastasi

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Testicular tumor epidemiology after 65 years old is different than in young adult.

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Testicular metastasis of malignant melanoma is rare.

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Testicular metastasis of a malignant melanoma demonstrate the severity of the disease.

We report the case of an 83 years old man supported for painless indurated and nodular lesion of the left testicle. Histological analysis identified a primary cutaneous melanoma metastasis although it has never been found on physical examination.

The discovery of a testicular mass should suggest first a germ cell tumor, despite in some populations (age over 60 years), other diagnosis are more frequent, including metastasis.

Due to rapid disease progression and high mortality rate within a short interval, a complete staging looking for other secondary locations must be done and a multidisciplinary care and palliative involvement must also be initiated in the context of metastatic melanoma.

[Epidemiology of urinary stones in the French military during the operation Serval]

OBJECTIVES

The renal colic crisis is a pathology frequently encountered in foreign operations recently conducted by the French army and often requires a medical repatriation in mainland France. Soldiers deployed in arid areas are at increased risk of developing urolithiasis. The purpose of our study is to analyze the risk factors, the frequency and the methods of management of symptomatic urinary stone disease for French military returnees for renal colic during Serval operation.

METHODS

Our study focused on French soldiers repatriated from Mali for a renal colic care between January 11th and November 30th, 2013. For each patient, we recorded: age, sex, deployment date, crisis date, personal and family histories of urolithiasis, initial medical treatment, diagnosis and treatment to return to France.

RESULTS

Three hundred and forty-eight soldiers were evacuated during Serval operation, among which 41 were due to the occurrence of renal colic crisis (11.7%). Twenty-nine percent of patients had a personal history of kidney stone disease symptomatically. The average residence time when the crisis appears is 60 days (10-120 days). Ninety-five percent of patients were asymptomatic at their arrival in France and 39% of patients had no stone found in CT scan. The average size of the stones found on the imaging was 2.71 mm (1-8mm). One patient required drainage by JJ ureteral endoprothese in order to have a quick ureteroscopy for recovery of its capacity.

CONCLUSION

The French military sent to Serval operation are exposed to multiple contributing factors of urolithiasis as the dehydration and the strong temperature. The analysis of our series reveals that the history of renal stone disease is the main factor favoring and the medical treatment is effective in almost all renal colic cases. The operational impact associated with this common condition in the Sahel region deserves an awareness of field practitioners to the screening and management of this disease in a precarious situation and a reflection of the staffs concerning the access onto the operating theater to appropriate diagnostic and therapeutic means that could facilitate the return to the combat unit.

[Mediastinal localization of a growing teratoma syndrome: a case report]

The development of testicular germ cell tumors may be marked by a rare phenomenon: the growing teratoma syndrome. It consists of residual masses, usually retroperitoneal and, more rarely, thoracic, that appear during or after chemotherapy, although the tumor markers are normalized. We report a case of posterior mediastinal localization. This mediastinal localization is very rare, and because of the proximity to intercostal arteries, induces a risk of postoperative paraplegia.

[Growing teratoma syndrome]

Growing teratoma syndrome (GTS) is a rare entity, characterized by enlarging masses of the retroperitoneum or other location occurring during or after systemic chemotherapy for the treatment of non-seminomatous germ cell of the testis (NSGCT). Three criteria define this syndrome: enlarging metastatic masses, normalized serum markers and no component of viable germ cell tumor in this mature teratoma. Prognostic is excellent after the resection of these masses, but this surgery has to be as much complete as possible. Surgical excision of large GTS lesions is technically challenging, a serious intraoperative complications may occur, that's why the treatment must not be delayed.

[Renal pseudotumoral actinomycosis: a case report]

We report the case of a 66-year-old man, presenting a right kidney mass with an alteration of the clinical status, treated by radical nephrectomy. Pathology reported that it was a pseudotumoral form of a bacterial infection: actinomycosis. This is an uncommon disease in this location. The authors wonder if it is possible to avoid nephrectomy with a preoperative diagnosis, especially with renal biopsy. The patient was well doing after 18 months thanks to long-lasting and effective postoperative antibiotics (Dhanani et al., 2004).