Biomedical subjects
Publications and source records attributed to F Richard.
This article concerns a case of anuria in a pregnant woman, apparently caused by compression of the urinary tract. The case is compared to the behavior of the excretory tract during a normal pregnancy. Four similar cases, taken from the literature are also discussed.
Schistosoma haematobium eggs may occasionally be found in the renal parenchyma, usually with no pathological consequences, the main risk to the kidney being obstruction of the urinary tract by bilharzial lesions. Egg deposits in the submucosa and muscles of the excretory tract induce obstruction and sclerosis, mainly in the ureters. Bilateral stenosing bilharzial ureteritis results in mechanical obstruction of the renal function, sometimes, unfortunately, accentuated by sepsis and pyelonephritis. This condition is a strong indication for surgical repair of the stenotic lesions of the urinary tract, which must be performed before the onset of irreversible damage to the renal function.
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The semiology and evolution of vesicosphincteral disorders have been studied in a series of 100 cases of multiple sclerosis. All the patients underwent a complete checkup and were followed over a period of 6 years. Mictional problems appear within the first five years in 60 p. cent of cases. When they occur later on, they tend to follow the evolution of the disease on their own. There exist regular correlations between the gravity of the motor and sphincteral handicap, and between the size of the postmictional residue (over 20 p. cent of the miction), the time elapsing since the onset of the mictional disorders, and the appearance of uronephrological complications.
Nine cases of malignant adrenal cortical tumour treated during the last decade are reported. As in many other series, these rare tumours were predominant on the left side (7/9) and affected mainly adult females (6/!) with a mean age of 44 years. The 8 secretory tumours were revealed by their hormonal effects: endocrine syndrome or arterial hypertension. The single, clinically non-secretory tumour presented as a palpable mass. The most common findings of hormonal exploration undertaken in 8 of the 9 patients were abolition of the cortisol nycthemeral cycle and non-response to dynamic tests. In 8 cases the tumour was demonstrated by intravenous urography, but its location and extension were best shown by CT scans. Two scintigraphies performed with labelled iodocholesterol were positive. All patients underwent complete excision of the tumour: 5 out of 9 had hepatic metastases at the time of surgery. The median survival of the 7 patients who died was 13 months; 6 of these had received Op'DDD (mitotane) post-operatively. Two patients, including one treated with Op'DDD, are still alive after 18 and 32 months respectively, without signs of recurrence.
Basing themselves on 149 cases, the authors describe the spinal neurophysiology of ejaculation in spinal man, and put forward certain hypotheses. They suggest that the reflex of seminal emission is a lumbar reflex, which may be dependent on conductive factor originating in the upper neurological structures, and that the orthosympathetic system, which leaves the spinal cord through the thoracolumbar junction, could provide a highway for the psychological nerve impulses inducing seminal emission.
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The urinary rehabilitation of children suffering from acquired paraplegia is here the subject of a retrospective study of 29 patients observed over a long period. The study shows that the detrusor-sphincter balance cannot be exploited on a personal level before the age of 10 ; bacteriuria and persistent residue after the initial period may ultimately disappear under discontinuous bacteriostatic treatment and thanks to the acquisition of autonomy in relation to the residue ; out of the total of 29 patients, the authors only noted 3 morphological and functional deteriorations requiring cutaneous diversion by Bricker's method. Today, the number would have been even smaller thanks to better knowledge of the striated sphincter syndrome, which accounted for 2 of the 3 cases noted. At last in the case of 16 of the 20 initial results considered as favourable, in other words in a little over 3 out of 4 patients, the social and uro-nephrological situation is holding steady, and even improving.
A series of 222 cases of adenocarcinoma of the kidney are discussed. Many of these cases involved extended carcinomas (stages III and IV, 65 p. cent; stage IV, 41 p cent). The surgical procedures used included 204 extended nephrectomies, 4 partial nephrectomies and 14 laparotomies for the exploration of unextirpable cancers. The mortality rate was 4.5 p. cent and the morbidity rate, 22 p. cent. 168 patients were followed up over a long period after an extended nephrectomy (8 died postoperatively and contact was lost with 28 patients after their operations). The 5-year survival rate was 71 p. cent for stage I, 77 p. cent for stage II, 48 p. cent for stage III and 23 p. cent for stage IV.
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Success in the management of urethral strictures can be claimed only after many years, patients sometimes faring well for ten years or more before suffering a recurrence. We used endoscopic urethrotomy as primary treatment for a variety of urethral strictures in 123 patients. Follow-up is over two years for 63 patients and more than five years for 18. Over-all success rate at five years was 76 per cent. Failures are twice as frequent in strictures, regardless of their origin, involving the anterior urethra than in the bulbar or posterior urethra. Two-thirds occurred in the first year of follow-up, but, as in other techniques, recurrence can occur after four years.
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