[Renovascular arterial hypertension caused by stenosis of a branch of the renal artery. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to M Ayed.
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Lesions of seminal vesicles during urogenital schistosomiasis are a frequent finding but their manifestation as a palpable mass is a rare feature. An exceptional case of a large schistosomial spermatocyst is reported in which diagnosis was by histopathology.
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The authors report their experience about 26 cases of urethral instability. This dysfunction is not rare; both sexes are involved, children was well as adults. Diagnosis is based on the data of simultaneous urethro-cystometry. Three clinical patterns are recognized: intermittent urinary leakage (6 cases), frequency and urgency (3 cases) and enuresis (17 cases). The urethral instability was pure in 13 cases and associated to detrusor hyperactivity in the other thirteen. But, in one of these the bladder instability was pure. A treatment based on alpha-adrenergic drugs has assured clinical relief and urodynamic stabilization of bladder and urethra.
Traumatic lesions of posterior urethra pose a problem in management because of the difficult access behind the pubic position. Twelve successful results among fourteen patients are treated by perineum transpubic surgery. The direct attack upon the lesion constitute the superiority of this approach.
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The authors present a critical study and retrospective of 36 cases of hematuria without urographic anomalies. Renal angiography was performed in 69% of the patients. 84% of these angiograms were negative. Only 2 identified the cause of the bleeding. 28% of the patients underwent disappointing surgery. In 40% of the cases the appearance of the kidney was normal. Only one of the 6 nephrectomies was justified. The authors recommend the use of modern and non invasive methods of investigation.
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Hydatid cysts of the kidneys were explored by ultrasound in 43 patients between 1978 and 1982, diagnosis being confirmed by operation. Cases included 33 adults and 10 children under 15 years. Ultrasound images of renal hydatid cysts are analyzed, and correlated with the classification into 5 types proposed in the literature and based on their natural history. This non-invasive technique, when associated with intravenous urography, is of primary diagnostic importance, particularly in countries where these cysts are endemic. Ultrasound imaging assists positive diagnosis in a large number of cases, acts as a guide to complementary explorations when these are required, and enables detection of extrarenal locations of hydatidosis. Differential diagnosis of ultrasound images is discussed, and emphasis placed on the advantages of using this technique in countries where the affection is endemic, particularly its low cost.
The authors report a case of malignant cortico-adrenaloma in a young woman of 27. This malignant tumour represents 10% of the causes of Cushing's syndrome. It is noted for the rapid onset of the syndrome and a marked hyperandrogenism. The diagnosis depends on an I.V.P. with retropneumoperitoneum completed by arteriography and ultrasound or by more recent investigations: the isotope scan and the C.T. scan. Its prognosis is very poor and the treatment consists of an extended adrenalectomy.
The authors report a series of 78 cases of hydatid cyst of the kidney collected during the past 17 years. There study material is based upon 72 IVU, 19 retrograde urograms, 22 renal arteriograms, 58 laboratory examinations, 12 renal echographies and 76 surgical operations. The usual presenting symptoms consist of lumbar or lumbo-abdominal swellings, lumbar pain, renal colic, hydaturia and haematuria, whilst bearing in mind that cysts of the upper pole of the right kidney may present with digestive problems as their first symptoms. Almost half of these cysts were calcified. The appearances by IVU were of a renal tumour. In endemic areas, the presence of calcifications is fairly typical of hydatid cyst. In the absence of calcifications, the IVU appearance is that of a renal cyst or carcinoma. The diagnosis is based upon the following: hydaturia, the existence of a second hepatic or pulmonary lesion and positive serological reactions. Renal echotomography has radically transformed the diagnostic approach since although recent, this investigation is reliable and shows identical appearances in the kidney to those found in hydatid cysts of the liver. The use of echography has made it possible to limit arteriography to heterogeneous masses with a solid component. Improved knowledge of echotomography should make it possible to avoid the topographical errors in which a renal hydatid cyst is thought to be in the liver. In the opinion of the authors, treatment should be surgical, whatever the procedure including sterilisation of the cyst by the injection of hypertonic saline and removal of the hydatid, i.e. the cyst ("kystectomy"). After these basic steps the surgeon may decide between simple resection of the protruding part of the cyst (partial perikystectomy, 25 cases) or ablation of all the adventitia (total perikystectomy, 26 cases). When damage to the renal parenchyma is too extensive, nephrectomy may be necessary (19 cases).
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We report the case of a xanthogranulomatous pyelonephretis in a pelvic ectopic kidney that is revealed by a buttockal abscess.
A case of large retrovesical tumor in a 50 year-old man is reported here. The diagnosis of schistosomial spermatocyst was made by histopathology. The authors underline the difficulty of the topographic diagnosis in large retrovesical masses.
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