Biomedical subjects
Publications and source records attributed to A Benchekroun.
The authors report a case of renal endometriosis. The preoperative diagnosis of this pathology is difficult because the clinical aspect and the radiological appearance are non specific. This fact limits the place of the medical treatment and of the conservative surgery nevertheless desirable in this young population.
Malignant mesothelioma of the tunica vaginalis is a rare and aggressive tumor. It appears that surgery have a high value in the treatment. We report a case of malignant mesothelioma of the tunica vaginalis in 65 years old patient and a review of the literature is presented.
The case files of 198 patients with a stone, treated by percutaneous nephrolithotomy between 1985 and 1999, were studied. This series consisted of 113 men and 85 women with a mean age of 41 years (17-71 years). The stone was in the pelvis (167 cases) of the kidney, multiple in 40 cases and staghorn in four cases. The complications were septic in six cases and hemorrhagic in five cases. The overall stone-free rate at three months was 92%.
Between 1986 to 1998, 40 patients, 16 to 52 years old, consulted for trauma of the scrotum. The trauma was closed in 36 cases. The trauma occurred by accident of traffic in 19 cases, an accident of work in seven cases, an accident during sport in seven cases, aggression in six cases and brawl in one case. The clinical symptomatology was dominated by inflammatory big scrotum or haematoma in the tunic. Ultrasound imaging was performed in 20 patients, showed a contusion of the testicle in five cases, haematoma of the scrotum in ten cases and albuginal rupture in two cases. Thirty patients underwent surgical repair. Five patients underwent orchidectomy. Atrophy of the testis occurred in two patients who underwent resection of the pulp and two others who had haematoma of the haematocele.
The authors report a case of sarcomatoid carcinoma of the prostate in a 49-year-old patient. The clinical symptoms were dominated by dysuria and frequency. Digital rectal examination showed a very large, hard and irregular prostate. Serum PSA was normal. Transrectal ultrasonography and abdominopelvic computed tomography showed a heterogeneous mass occupying the vesico-prostatic junction. The patient underwent cystoprostatectomy. Histological examination of the cystoprostatectomy specimen revealed a tumour composed of spindle cells expressing epithelial markers on immunohistochemical analysis and concluded on a diagnosis of sarcomatoid carcinoma of the prostate. The patient died seven months after cystoprostatectomy.
Spontaneous subcapsular haematoma (SCH) of the kidney is a rare condition, secondary to kidney tumours in more than 50% of cases. Nephrectomy is justified in the presence of tumour or uncontrolled haemorrhage. When the aetiology cannot be determined, thin-slice CT follow-up of the patient's kidney can be performed. The authors report 5 cases of SCH of the kidney. A retropelvic aneurysm was responsible for the haematoma in one case; polyarteritis nodosa was the cause of bleeding in another case and the aetiology could not be determined in two cases. All patients were managed surgically. Nephrectomy was performed in 3 cases and simple evacuation of the haematoma was performed in 2 cases.
The authors report the case of a 45-year-old patient who presented with a left latero-aortic paraganglioma associated with gastric schwannosarcoma. Treatment consisted of resection of the chromaffin tumour and the gastric tumour, with a favourable course at last follow-up. The authors review the literature on this subject.
Wolfram's syndrome is an autosomal recessive neurodegenerative disease. The major manifestations consist of diabetes mellitus and bilateral optic atrophy and are sufficient to establish the diagnosis. Urinary manifestations constitute an integral part of the syndrome, as they are present in up to 62% of cases and represent one of the major causes of morbidity. Three cases allow emphasize the difficulty of treatment, which is essentially symptomatic, and largely guided by the results of the various complementary investigations, especially urodynamic assessment. Although the causes of this syndrome are multifactorial and complex, it appears that the urinary lesions are at least temporarily improved by correction of excessive bladder pressure.
PURPOSE: Wide ureters have a high risk of urinary reflux if they are implanted in the intestinal segment. Since 1978, we used the continence hydraulic valve as an antireflux device without staples. MATERIALS AND METHODS: A total of 40 patients, 20-65 years old (mean age 50), 36 with bilaterally severely dilated ureters and 4 with unilaterally dilated ureters underwent reconstructive surgery by intestinal segments with a hydraulic antireflux valve (HAV). RESULTS: Mean follow-up was 62 months (range 14-110); upper tract dilatation had improved or stabilized in all patients but one in whom bilateral dilatation occurred with HAV stenosis. All patients underwent follow-up loopogram studies which revealed 2 cases of reflux (4 ureterorenal units). In 1 of the 2 patients the urinary reflux occurred after dessusception (disinvagination) of the nipple. CONCLUSIONS: The HAV is a safe and reliable procedure in preventing reflux when implanting wide ureters into intestinal segments. This technique can be used in continent urinary diversions with intestinal pouches, and can also be used at the proximal level of an ileoureteroplasty. There is no need for staples.
Emphysematous pyelonephritis is rare. It is exceptionally associated with urolithiasis with obstruction of the collecting system. It is generally observed in female diabetic patients. It is caused by gas-producing bacteria. We report a case in which emphysematous pyelonephritis was caused by an acinetobacter, associated with pelvic ureteral junction lithiasis. Drainage and nephrectomy were necessary to overcome this life threatening situation.
OBJECTIVES: Analysis of the treatment of a series of patients with adrenal cortical carcinoma. MATERIAL AND METHODS: This series consists of 22 patients (15 women and 7 men) with a mean age of 35 years (range: 23 to 58 years). 55% of patients had a non-secreting tumour; 45% of tumours were associated with excessive hormonal secretion. The tumour was located on the right side in 12 cases and on the left side in 11 cases (the tumour was bilateral in 1 case). Ultrasound and CT were sufficient for localization of the tumour. The patients were classified as stage I: 3 cases, stage II: 2 cases, stage III.: 8 cases, stage IV: 9 cases, according to MacFarlane's classification. RESULTS: Adrenalectomy was performed in 18 patients. Two patients died during the operation and another 8 died within the first four years. Eight patients are currently alive, including 7 with no signs of recurrence; one patient presented a large local recurrence 39 months after adrenalectomy. CONCLUSION: Surgery remains the only effective treatment at the present time. The diagnosis of adrenal cortical carcinoma must be made as early as possible.
The authors report a case of nephrogenic metaplasia of the ureter in a 35-year-old patient presenting with left low back pain, haematuria and frequency. Physical examination was not contributive. IVU showed a filling defect in the left iliac ureter. Ureteroscopy demonstrated a tumour nodule in the left iliac ureter. Ureteroscopic biopsy with histological examination showed nephrogenic metaplasia of the ureteric mucosa. Treatment consisted of ureterotomy with resection of the ureteric polyp, followed by closure of the ureterotomy over a double J stent. The course was favourable and postoperative follow-up (IVU, cystoscopy) at 6 months and 12 months was normal.
We report three cases of retroperitoneal liposarcoma. Two patients required multiple surgical excisions for locoregional relapse diagnosed by surveillance based on CT-scan. One patient had radiotherapy. With the literature review we discuss the pathologic and therapeutic aspects of these lesions.
There has been an increase in the frequency of candidiasis urinary infections, which mainly affect diabetic or immunodepressed patients. However, the obstruction of the upper urinary tract by fungal infection is a rare occurrence. The introduction of novel antifungal agents has improved the treatment of fungal infection. In this study, two cases have been reported of urinary candidiasis infections with obstruction of the upper urinary tract which were successfully treated with fluconazole in combination with ureteral catheterization.
The authors report a case of adrenal ganglioneuroma in a 25 year old woman. This rare and benign tumor is localized in the adrenal gland in 20% of cases. Considerations on diagnosis, pathogenesis and management are discussed.
In cases of staghorn lithiasis, the calculus is formed in the excretory cavities of the kidney. It is considered to be a severe type of calculus due to its effect on renal function, associated urinary infection, and its frequent recurrence. In the present study, 98 cases of staghorn calculi have been reported, which were treated over an 8-year period (1990-1997). The patient population consisted of 56 women (62%) and 34 men (38%). The mean age was 46 years (age range: 20-73 years). A history of urolithiasis was noted in 23 cases (26%). The mean time from the onset of symptoms to diagnosis was four years. The clinical symptomatology was as follows: in the right kidney was involved in 54 cases, and both kidneys were affected in eight cases. The calculus was radio-opaque in 94 cases (96%), complete in 29 cases (29%), partial in 69 cases (71%), and associated with caliceal extension in 36 cases (40%). In 47 subjects (52%) other lithiasic sites were found, i.e., caliceal in 41 cases, and ureteral in six cases; Impairment of the renal parenchyma was noted in 33 cases (45%). Urinary infection were found in 30 cases (34%). Renal function was impaired in 15 patients. Staghorn lithiasis was severe in a significant number of subjects, i.e., in 59 cases (60%). Surgical treatment consisted of nephrolithotomy (37 cases), pyelonephrolithotomy (28 cases), pyelolithotomy (18 cases) total nephrectomy (14 cases), and partial nephrectomy (one case).
The authors analyse of a series of 26 patients (17 females and 9 males) with a mean age of 32 years (range: 18 to 55 years) operated for adrenal phaeochromocytoma. All patients were hypertensive. The laboratory assessment (assay of blood catecholamines and urinary catecholamine metabolites) performed in more than 2/3 of cases confirmed the diagnosis in more than 80% of cases. The topographic diagnosis was facilitated by computed tomography. Fifteen patients received preoperative treatment with alpha-blockers or calcium channel blockers. Various incisions were used, but a lumbar incision was the most frequent. Blood pressure was controlled postoperatively in 24 patients. Two patients died 1 and 2 postoperatively. New diagnostic modalities (CT, MRI) have facilitated the diagnosis and the site of localization of phaeochromocytomas, thereby improving the choice of incision. Patient-specific preoperative preparation and appropriate anaesthesia facilitate successful adrenal gland surgery.
The kidney is a rare site of hydatid disease. It remains clinically silent for a long time and only presents at the stage of complications. The diagnosis is essentially radiological. Renal hydatid cyst (RHC) raises therapeutic problems due to its complications, which sometimes make kidney-preserving cyst resection surgery difficult. The authors report a series of 45 cases of RHC treated in their department during a 20-year period. This series consisted of 27 men and 18 women with a mean age of 47 years (26-80 years). The clinical features were dominated by pain (80%), flank mass (42%), hydaturia (22%), haematuria (13%), urinary tract infection (6%), hypertension (3%). IVU, performed in all patients, showed calcifications in 35% of cases, renal tumour syndrome in 71% of cases and silent kidney in 22% of cases. Surgery was usually performed via a lumbar incision (75%) or a BARAYA incision (15%). Treatment consisted of 18 cyst roof resections (40%), 6 pericystectomies (13%), partial nephrectomy in 2 cases (4%) and total nephrectomy in 18 cases (40%). The postoperative course was marked by urinary fistula in two patients and one death at the 2nd postoperative month related to associated renal sarcoma. The objective of this study is to analyse the epidemiological, pathological and therapeutic features of this disease, which still constitutes a public health problem in Morocco.