Biomedical subjects
Publications and source records attributed to L Salomon.
Painful scrotum is a frequent symptom. Clinical examination is essential and provides a diagnosis in 85% of cases. In the case of a doubtful diagnosis, ultrasonography is the best complementary investigation. The physician must continually keep two diseases in mind: torsion of the testis and testicular tumour.
Epidemiology. The incidence of benign prostatic hyperplasia (BPH) has increased in proportion to the life expectancy and has become the third leading cause of health expenditure in industrialized countries. Eighty per cent of men are treated for benign prostatic hyperplasia during their lifetime. In Europe, the mean age of diagnosis is 65 years. The clinical symptoms are assessed by the IPSS score (International Prostate Symptom Score) and by the maximum flow rate, where frank dysuria is defined as a flow rate of less than 10 ml/sec. Physiology. The prostate contains equal proportions of glandular epithelial structures and fibromuscular connective tissue stroma. The glandular prostate is innervated by cholinergic nerves, while the smooth muscle of the stroma and the urethra are innervated by adrenergic nerves. BPH arises in the transitional zone (fairly glandular). Androgen deprivation (castration, antiandrogens, progestogens, 5-alpha-reductase inhibitors) induces a 30% reduction of the prostatic volume (especially epithelial). BPH could be due to reactivation of the embryonic potential of the stroma. Certain growth factors appear to be involved in BPH. Inflammatory and immunological phenomena may also be involved. Evaluation. Plan of clinical interview, clinical examination and laboratory and radiological data. A 40-year-old man has one chance in 30 of being operated for benign prostatic hyperplasia if he lives to the age of 80. Medical treatments have been developed since 1980 which inhibit the course of BPH and minimize some of the clinical symptoms: plant extracts, alpha-blockers, 5-alpha-reductase inhibitors. Conventional surgical treatments, open prostatectomy and endoscopic resection, have been completed by laser therapy, thermotherapy and cryotherapy.
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On the basis of one personal case and 63 cases reported in the literature for patients operated from 1958 onwards, the authors assess the surgical treatment of aneurysms of the celiac trunk. These are rare (4% of all visceral aneurysms), often latent (41.3% of cases) or without any specific symptoms (36.2% of cases), and have an atheromatous (51.8% of cases) or dysplasic (38.8% of cases) origin in most cases. They mainly affect men (68.4% of cases) after 40 years of age (72.2% of cases). They are rarely identified during the clinical examination, but are detected by ultrasound and confirmed by computed tomography and/or angiography (51.8% of cases). They are often small, less than 50 mn, and their size is a criterion for the approach, which usually remains abdominal. Resection is a routine operation (84.3% of cases), but the continuity of the artery is restored in 78.3% of cases only, due to the good-quality replacement provided by the superior mesenteric artery. The operative mortality rate is 7.8%. There are 96.2% good results (2 recurrences), but the average lapse in time is only 15.75 months.
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