Biomedical subjects
Publications and source records attributed to M Ayed.
The authors report a series of nine reno-ureteral obstructive uric acid calculi initially treated by percutaneous nephrostomy. After attempting stone dissolution by in situ alkalinization, they discuss the place of such a method among the various treatments for uric acid stones.
Fourteen patients (12 men, 2 women) with spondyloarthropathies underwent bronchoalveolar lavage (BAL), transbronchial biopsy (TBB) and other respiratory investigations. BAL revealed lymphocytosis and increased nonaltered neutrophil polynuclears in a smoker and an isolated lymphocytosis in one patient with restrictive syndrome and radiographic apical fibrosis. TBB showed interstitial fibrosis in the 2 patients and in 3 others who are all nonsmokers and among whom 2 had a restrictive syndrome. Subclinical alveolitis in spondyloarthropathies is absent. Interstitial fibrosis is not rare and its frequent association in a restrictive syndrome suggests a mechanical origin.
We report a case of mucin-producing adenocarcinoma of the urachus. Preoperative diagnosis was established by computerized axial tomography. An en bloc resection was performed, including the urachus with supravesical mass and bladder dome.
Calcified necrotising cystitis is an urological curiosity, the authors report two cases. With subsidence of the acute process, regeneration and fibrosis take place, with contracture of the bladder and reduction of its capacity. Augmentation ileocystoplasty was performed with success in one case. The clinical and therapeutic aspects of this rare disease are discussed.
The authors report a series of 9 reno-ureteral obstructive uric acid calculi with recourse first to percutaneous nephrostomy. After attempt of stone dissolution by in situ alkalinization, the role of such a method among other uric acid stones management techniques is discussed.
The authors report on the results of 40 cases of cervico-prostatic incision for benign prostatic hypertrophy. Evaluation of the prostatic gland was based only on rectal examination. Operative technique is simple. We have treated patients with prostatic hypertropy less than 30 g. Young men with prostatic hypertrophy greater than 30 g have been treated by this technique, to preserve antegrade ejaculation. Success rate was 90% at 6 months and 85% at 18 months. Retrograde ejaculation was observed in 21% of the patients following treatment.
We report our experience of 4 urine fistulas and 4 ureteral strictures after renal transplantation. Percutaneous nephrostomy was performed on all patients. The diagnosis was established by antegrade pyelography. Nephrectomy was performed on 2 patients because of failure of drainage and formation of an infected urine collection due to an extended ureteral necrosis. Abstention was elected in one case as renal function did not improve due to associated chronic rejection. In 5 cases, renal function quickly improved with drainage: 2 were operated on immediately, and one after failure of endo-urological treatment of a urine fistula. Antegrade dilatation has been used successfully in one stenosis. In the last case, a double pigtail stent allowed a urine fistula to close. Percutaneous nephrostomy seems to be best method of drainage when ureteral obstruction or fistula is suspected in renal transplant patients, and permits diagnosis by antegrade pyelography. Percutaneous management may be a satisfactory way of treatment for limited stenosis or fistulas.
It is often stated that younger patients have a better prognosis than their older counterparts. From the records of 17 men and 2 women, aged 40 years or less it appears that bladder carcinoma in patients 30 years-old or less have a favorable prognosis. Disease occurring at age 30 to 40 has a much worse prognosis and is no different from that affecting the older age groups.
A case of spontaneous subcapsular hematoma of the kidney is reported. CT scan findings and etiologies are examined in the light of previously published data. An etiology-specific therapeutic strategy for subcapsular hematoma of the kidney is proposed.
The authors report the case of a patient presenting with both a bladder tumor and urinary tract tuberculosis. The bladder tumor was treated by transurethral resection and instillation of mitomycin C. The author describes this case and discusses this unusual association.
The authors report about a series of 60 cases of superficial (Ta and T1) bladder tumors and study their evolution towards infiltration according to the grade, size and number. 16% of the T1 tumors evolved towards infiltration and/or metastatic spread after a period of 42 months. In our opinion, T1 tumors can be regarded as superficial tumors. However, our therapeutic attitude is cautious because of pejorative factors of prognosis: high grade, multiple foci, and size exceeding 5 cm.
We report two cases of urinary incontinence secondary to ectopic ureteral implantation with pyeloureteral duplication in a 14 and 18 year-old girls. Our observations are discussed with the review of the world publication about this data.
In order to determine the frequency of acute renal failure (ARF) induced by drugs, to identify the agents responsible for it and to define its semiological characteristics, a prospective study was carried out between 1 October 1987 and 30 September 1988, in Sfax and southern Tunisia. Three Departments of Medicine and one Hemodialysis Center participated in this study. Twelve cases of drug-induced ARF were identified among the 73 cases of ARF reported, i.e., a frequency of 16%. Anti-inflammatory non-steroidal drugs (AINS) were implicated in 5 cases and antibiotics in 2. Symptoms of hypersensitivity were observed in 4 patients, 2/3 without oliguria. Renal insufficiency was usually marked: plasma creatinine was 523 +/- 425 mumol/l; proteinuria greater than 1 g/24 h was seen in 2 patients. Hypovolemia and/or hypotension (6 cases) and diabetes mellitus (4 patients) were found to favor ARF. Renal function returned to normal in 9 patients, whereas mild renal failure persisted in the remaining 3 patients. Drug-induced ARF occurs often. AINS are the most frequently incriminated agents and hypersensitivity symptoms without oliguria are the most common manifestations. Drug-induced ARF can be prevented by close monitoring of high-risk patients, i.e., those taking AINS.
From January 1988 to October 1989, 17 patients underwent radical cystectomy for bladder cancer. They had a bladder replacement by Hautmann pouch. Good results were obtained after a period of observation of 6 to 24 months. Two patients died. Hyperchloremic acidosis was observed in 20% cases. The urinary continence was achieved in 13 patients who were willing to wake up twice every night. One patient preferred the collecting device. Our study showed that the Hautmann pouch is a particular low pressure reservoir with a capacity of 200 ml to 800 ml, and assessed the mechanism of loss of urine at night in one case. The urinary continence was achieved after a good training period and depended on patient's cooperation. This technique permitted to obtain a very satisfactory diurnal and nocturnal continence in our patients, however a longer follow up is mandatory to confirm the efficiency of this method on long term basis.
The authors report a case of a large penile skin and urethral defect repair using a scrotal myocutaneous flap. The modalities, advantages and defects of the method were detailed. This technique permitted to obtain a very satisfactory result. Then we extended it to the failures of the hypospadias and epispadias reconstruction.
Kidney transplantation is actually the best replacement therapy for the end stage renal failure. It sets free the hemodialysed patient from the hemodialysis restraint and contributes to solve the socio-economic problems risen by chronic hemodialysis. The authors report the results of this technic during the first 30 months of kidney transplantation in the "Hôpital Charles Nicolle" of Tunis. They describe the first steps which led to kidney transplantation, the therapeutic regimens, the medico-legal problems and the specific complications observed during this start period.
The authors report the case of an ectopic pheochromocytoma without any clinical symptoms or laboratory signs which simulated a renal tumor during clinical and complementary investigations. The diagnosis was established by histology. The ectopic pheochromocytoma and the diagnostic problems of silent tumors are discussed.
The goal of this presentation is to report the results on morbidity and continence of 20 consecutive patients who, from January 1985 to December 1988, underwent bladder reconstruction after cystectomy for bladder cancer. In ten cases the neo-bladder was a classic ileocystoplasty and in the ten others it was a "low pressure neo-bladder". We compared the two groups although they were not randomized. There was no stadification difference in tumors nor in clinical status. The clinical results were described. There have been four temporary urinary fistulas in the group of low pressure bladder (LPB), and four in the group of classic ileocystoplasty (CI). In the group of LPB, 7 from 8 patients were completely dry day and night and voided every two for three hours while among the 9 patients with CI, 4 were continent day and night.