RESUMEN
Bladder cancer (urothelial carcinoma in 90 % of cases) is the most common neoplasia of the urinary tract. Superficial carcinoma represents 70-80 % of bladder cancers. The treatment of these tumours includes, after transuretral resection, intravesical Bacillus Calmette-Guerin (BCG) instillation therapy. This treatment constitutes, by its immune-mediated anti-tumoral action, the first step of immunotherapy in cancer. Severe complications (granulomatosis, hypersensitivity pneumonitis or orchitis) are rare (0.5-2 %). Here we report a complex case of pulmonary granulomatosis secondary to BCG therapy. This is a 74-year-old male, treated for superficial bladder carcinoma by transuretral resection (pT1G3) and then endovesical instillations of BCG therapy for two months. Two years later, a new transuretral resection shows an infiltrating urothelial carcinoma pT2G3. The extension balance finds a persistent micro-nodular pulmonary infiltrate. A broncho-alveolar lavage is then realised but no mycobacteria was found. A surgical biopsy of a nodule is performed and revealed a histiocytic reaction without any neoplastic element. Detection of Mycobacterium tuberculosis by Polymerase Chain Reaction (PCR) was finally positive. In the absence of a secondary lesion, the patient had a cysto-prostatectomy and began a tritherapy against tuberculosis. Post-BCG therapy granulomatosis is a rare complication but should remain a differential diagnosis in front of the appearance of pulmonary nodes in patients who have received posttransuretral resection BCG instillations. Mycobacterial DNA PCR research remains the most sensitive examination.
Les carcinomes urothéliaux superficiels de vessies représentent 70 à 80 % des tumeurs de la vessie. Leur traitement comprend, après résection transurétrale, une BCG (Bacille de Calmette et Guérin) thérapie par instillations endovésicales. Les complications sévères (granulomatose, pneumopathie d'hypersensibilité ou orchite) sont rares (0,5-2 %) mais nous rapportons ici un cas complexe de granulomatose pulmonaire secondaire à une BCG thérapie. Il s'agit d'un homme de 74 ans, traité pour un carcinome urothélial superficiel de vessie par résection endo-urétrale (pT1G3) puis instillations endovésicales de BCG thérapie. Deux années après, une nouvelle résection transurétrale objective un carcinome urothélial infiltrant pT2G3. Le bilan d'extension retrouve un infiltrat pulmonaire micronodulaire persistant. Un lavage bronchoalvéolaire ne retrouve pas de bacilles acido-alcoolo-résistants. La biopsie chirurgicale d'un nodule retrouve une réaction histiocytaire sans élément néoplasique. La Polymerase Chain Reaction (PCR) à la recherche de mycobactérie du groupe tuberculosis revient finalement positive. En l'absence de lésion secondaire, le patient a bénéficié d'une cystoprostatectomie et a débuté dans les suites une trithérapie antituberculeuse. La granulomatose post-BCG thérapie est une complication rare, mais doit rester un diagnostic différentiel devant l'apparition de micronodules pulmonaires chez les patients ayant reçu des instillations de BCG post-résection transurétrale. La recherche par PCR d'ADN de mycobactéries reste l'examen le plus sensible.
Asunto(s)
Mycobacterium bovis , Tuberculosis Miliar , Tuberculosis Pulmonar , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Administración Intravesical , Anciano , Humanos , MasculinoRESUMEN
Anaerobic digestion is a significant process leading to biogas production and waste management. Despite this double interest, professionals still face a lack of efficient tools to monitor and manage the whole procedure. This is especially true for rheological properties of the material inside the reactor, which are of major importance for anaerobic digestion management. However, rheological properties can hardly be determined in-situ and it would be very helpful to determine indicators of their evolution. To solve this problem, this paper investigates the evolution of sewage sludge rheological and electrical properties during the anaerobic digestion in a batch reactor. We especially focus on apparent viscosity and complex impedance, measured by electrical impedance spectroscopy. Both of them can be modelled by a linear combination of raw sludge and inoculum properties, weighted by time-dependent coefficients. Thus, by determining digested sludge electrical signature, it is possible to obtain those coefficients and model sludge apparent viscosity. This work offers many theoretical and practical prospects.
Asunto(s)
Bacterias Anaerobias/metabolismo , Reactores Biológicos , Modelos Químicos , Reología/métodos , Aguas del Alcantarillado/química , Administración de Residuos/métodos , Técnicas Electroquímicas , Aguas del Alcantarillado/microbiología , ViscosidadRESUMEN
The results of epidemiologic studies on the efficacy of different strategies of prevention or improvement of the prognosis of coronary artery disease are generally expressed in terms of percentage reduction of risk; for example, the treatment of hypercholesterolaemia reduces the risk of coronary death by 21%. In order to improve the assessment of the efficacy of these approaches the authors propose to take into account the number of subjects which needs to be treated each year to prevent one cardiovascular event more than the control group (for example, in hypercholesterolaemia, 1,736 patients). This number depends on the reduction of risk and also on the incidence of complications in the control group. Using this method, the authors classified different therapeutic strategies in order of their efficacy: thrombolytic therapy in the acute phase of myocardial infarction, then aortocoronary bypass grafting of left main coronary or triple vessel disease, secondary prevention with stopping smoking, and betablocker therapy. Finally, primary prevention with anti-smoking campaigns, treatment of hypertension and hypercholesterolemia. Based on this figure and knowing the annual cost of patient treatment, it is possible to calculate a cost-effectiveness ratio for each of these therapeutic interventions.
Asunto(s)
Enfermedad Coronaria/terapia , Métodos Epidemiológicos , Prevención Primaria/métodos , Antagonistas Adrenérgicos beta/uso terapéutico , Anciano , Puente de Arteria Coronaria , Enfermedad Coronaria/epidemiología , Análisis Costo-Beneficio/métodos , Femenino , Francia , Humanos , Hipercolesterolemia/prevención & control , Hipertensión/prevención & control , Masculino , Persona de Mediana Edad , Prevención Primaria/economía , Riesgo , Fumar , Terapia TrombolíticaRESUMEN
The authors report 13 cases of ureteral or periureteral sclerosis in a series of 330 cases of renal transplantation (3.9%): they occurred early, were asymptomatic (except for anuria); the renal cavities were always dilated, the renal function always deteriorated; the treatment was essentially surgical without mortality and with a low complication rate but 23% of the transplants were lost because of urological complications at 18 months. The authors compare their series with the literature.
Asunto(s)
Trasplante de Riñón/efectos adversos , Enfermedades Ureterales/etiología , Adulto , Anuria/etiología , Infecciones Bacterianas , Constricción Patológica/diagnóstico , Constricción Patológica/etiología , Constricción Patológica/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Esclerosis , Factores de Tiempo , Enfermedades Ureterales/diagnóstico , Enfermedades Ureterales/terapiaRESUMEN
The authors report the case of a woman who was transplanted with a cadaveric kidney. It was a cyst on the kidney; a biopsy was performed: it was a carcinoma. The transplanted kidney was removed. The second case was a man, transplanted with a cadaveric kidney, with a tumor at the lower pole: a tumorectomy was performed: it was a angiomyolipoma.
Asunto(s)
Adenocarcinoma/etiología , Hemangioma/etiología , Neoplasias Renales/etiología , Trasplante de Riñón/efectos adversos , Lipoma/etiología , Lesión Renal Aguda/cirugía , Adenocarcinoma/cirugía , Adulto , Biopsia , Femenino , Glomerulonefritis/cirugía , Hemangioma/cirugía , Humanos , Neoplasias Renales/cirugía , Lipoma/cirugía , Masculino , NefrectomíaRESUMEN
The authors report on a case of a emphysematous pyelonephritis due to Klebsiella pneumoniae, occurring in a diabetic patient and successfully treated by nephrectomy. They compare it to the literature.
Asunto(s)
Nefropatías Diabéticas/diagnóstico , Enfisema/diagnóstico , Pielonefritis/diagnóstico , Nefropatías Diabéticas/cirugía , Enfisema/microbiología , Enfisema/cirugía , Femenino , Humanos , Infecciones por Klebsiella/diagnóstico , Infecciones por Klebsiella/cirugía , Persona de Mediana Edad , Nefrectomía , Pielonefritis/etiología , Pielonefritis/microbiología , Pielonefritis/cirugía , Tomografía Computarizada por Rayos XRESUMEN
The authors report a case of bladder stones after urethro-vesical suspension, due to non absorbable suture material in the bladder. After surgical treatment, new stones were found, removed transurethrally with a good result after two years.
Asunto(s)
Suturas/efectos adversos , Cálculos de la Vejiga Urinaria/etiología , Vejiga Urinaria/cirugía , Vagina/cirugía , Adulto , Femenino , Humanos , Recurrencia , Incontinencia Urinaria de Esfuerzo/cirugíaRESUMEN
The authors report a case of decompensated pyelo-ureteric junction obstruction in a renal transplant patient with anuria on the 27th day, while the IVP (on the 22nd day) was normal. They compare this case with the literature.
Asunto(s)
Hidronefrosis/etiología , Trasplante de Riñón/efectos adversos , Obstrucción Ureteral/etiología , Adulto , Humanos , Masculino , SíndromeRESUMEN
Among 336 consecutive renal transplantations performed in our centre from March 1979 to December 1988, we have observed 26 cases of urinary leak in 25 patients. We have separated the ischemic and non-ischemic urinary leaks. The former (11 episodes) would have been prevented in most cases with better graft removal. The latter (15 episodes) were predominantly secondary to an anastomotic leak. We have treated surgically these urological complications. Only one patient died. The one-year graft survival rate was 67% in the 25 kidneys but the graft loss was directly due to the urinary leak in three cases.
Asunto(s)
Trasplante de Riñón/efectos adversos , Fístula Urinaria/etiología , Análisis Actuarial , Adolescente , Adulto , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Prótesis e Implantes , Cateterismo Urinario , Fístula Urinaria/cirugíaRESUMEN
The authors report a case of urinary calculi secondary to glafenine which posed a difficult problem in the radiological diagnosis. They review the literature of iatrogenic urinary calculi and discuss the place of radiology (Excretory Urography, Ultrasound and Computed Tomography) in the diagnosis.
Asunto(s)
Glafenina/efectos adversos , Cálculos Urinarios/inducido químicamente , Anciano , Femenino , Glafenina/metabolismo , Humanos , Tomografía Computarizada por Rayos X , Cálculos Urinarios/diagnóstico por imagen , ortoaminobenzoatosRESUMEN
We report on a young woman with anuric, terminal renal insufficiency whose bladder could not be used for renal transplantation. A Kock pouch was implanted during stage 1 of treatment and the capacity of the pouch was increased artificially with physiological saline solution. The patient subsequently underwent renal transplantation. Results were excellent with regard to continence and ease of catheterization. No complications due to infection were observed despite immunosuppression and electrolyte disorders were minor.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón , Derivación Urinaria/métodos , Adulto , Femenino , Humanos , Íleon/cirugía , Cateterismo UrinarioRESUMEN
The authors report on a case of a stenosis of a uretero-appendiculoplasty, treated by an ileal suspended loop, with a good result.
Asunto(s)
Bioprótesis/efectos adversos , Hidronefrosis/etiología , Fibrosis Retroperitoneal/cirugía , Obstrucción Ureteral/etiología , Apéndice/cirugía , Humanos , Hidronefrosis/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Radiografía , Uréter/cirugía , Obstrucción Ureteral/cirugíaRESUMEN
In a 22 years old woman with recent hypertension, a timed intravenous pyelogram revealed an asymptomatic obstructive ureteropelvic junction. Preoperative renal vein catheterization demonstrated excessive renin release from the diseased kidney and low release from the other one, suggesting that corrective ureteral surgery should return blood pressure to normal levels. Moderately impaired glomerular filtration rate improved after surgery as a consequence of suppressed hydronephrosis and bilateral renal ischemia. Thus we conclude that in young people, asymptomatic unilateral hydronephrosis can lead to hypertension and renal failure like renal artery stenosis. In the other cases of urinary flow obstruction, secondary hypertension remains to be explained by both inappropriate production of renin and water chronic retention.
Asunto(s)
Hidronefrosis/complicaciones , Hipertensión Renal/cirugía , Renina/metabolismo , Obstrucción Ureteral/complicaciones , Adulto , Femenino , Tasa de Filtración Glomerular , Humanos , Hidronefrosis/fisiopatología , Hipertensión Renal/etiología , Hipertensión Renal/fisiopatología , Pelvis Renal/anomalías , Pelvis Renal/cirugía , Radiografía , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Ureteral/cirugíaRESUMEN
Out of 1,000 optical cytological urine tests carried out over a period of two years, 84 isolated cases were "positive" and alerted 57 patients. These cases are analyzed by the authors with a follow-up period of 48 to 72 months: among those patients already under supervision for urothelial tumours, 40.4% showed urothelial recurrence of which 70%, that did not appear to carry a worse prognosis, were detected in the first twelve months. Since these patients usually underwent annual endoscopic examination, this meant that for 20% (i.e. 4.15% of the group under supervision) the diagnosis of recurrence could be made at least 6 months earlier. This alone is a justification for cytological examination which does not involve any complications but merely entails increased cystoscopic and biopsy tests. On the other hand, there appear to be no grounds to advocate mass "screening" except in populations with warning symptomatology (especially haematuria) for which the ratio of positive findings in this series was 2.3/1,000. The future development of automatic apparatus for cytological tests should obviate the significant personal factor involved in cytological examinations, as shown by a review of the literature.
Asunto(s)
Carcinoma de Células Transicionales/patología , Neoplasias Urológicas/patología , Carcinoma de Células Transicionales/diagnóstico , Reacciones Falso Positivas , Estudios de Seguimiento , Humanos , Recurrencia Local de Neoplasia/patología , Pronóstico , Neoplasias Urológicas/diagnósticoRESUMEN
Experimental data are presented here proving the accumulation of glycine in serum after transurethral prostatectomy and increased production of glycine metabolites: serine, alanine, glyoxylic acid, and glycolic acid. The presence of the metabolites glyoxylic acid and glycolic acid was demonstrated by gas-liquid chromatography and mass spectrometry. Glycine, glyoxylic acid, and glycolic acid possess neurological activity, so we examined the pathophysiology of the transurethral prostatectomy syndrome in view of the transient accumulation of these compounds in serum.
Asunto(s)
Glicina/sangre , Glicolatos/sangre , Glioxilatos/sangre , Prostatectomía , Anciano , Cromatografía de Gases y Espectrometría de Masas , Humanos , Masculino , Periodo PosoperatorioRESUMEN
The authors report one case of renal hydatid disease, with lithiasis and rupture into the renal pelvis. Pre-operative diagnostic investigation included ultrasound and CT scan imaging. Serologic test was negative. Treatment was surgical: removal of the hydatid and resection of the protruding part of the cyst. The fistula is closed with a drainage into the pelvis.
Asunto(s)
Equinococosis/complicaciones , Fístula/etiología , Enfermedades Renales/complicaciones , Adulto , Humanos , Cálculos Renales/complicaciones , Pelvis Renal , Masculino , Rotura EspontáneaRESUMEN
The authors report a case of a ureteral stenosis of a transplanted kidney. The cause was a compression by the spermatic cord. The treatment was surgical, with a ureteroureterostomy with pyelostomy tube intubating the anastomosis. A bit of the drain remained in the renal pelvis; it was removed by percutaneous nephroscopy.
Asunto(s)
Cuerpos Extraños , Trasplante de Riñón , Complicaciones Posoperatorias , Cordón Espermático , Enfermedades Ureterales/etiología , Constricción Patológica , Endoscopía , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Humanos , Pelvis Renal , Masculino , Persona de Mediana EdadRESUMEN
The authors report two cases of early transplant renal vein thrombosis after kidney transplantation. In the two cases, the graft had to be removed. Many difficulties prevented the diagnosis of this fortunately unusual (0.8% of all transplantations performed) vascular injury.