Biomedical subjects
Publications and source records attributed to M Camey.
The authors present an original antireflux uretero-ileal implantation. This procedure is based on the insertion of the ureter in a mucosal sulcus. The ileal mucosa progressively grows over the ureter. 260 ureters have been reimplanted according to this procedure. The antireflux system is effective in 85% of cases. The incidence of stenosis seems to be low: less than 2%.
We report 2 cases of renal tumor secondary to an esophageal cancer and discovered during an examination for hematuria. Despite the history the existence of a renal tumor with no apparent metastatic spread and hematuria justified nephrectomy, which led to the confirmation of metastasis to the kidney. Metastases of esophageal cancers represent only 4.8 per cent of secondary renal tumors. The kidneys are the fourth most common metastatic site of esophageal cancers, generally associated with several other secondary localizations. Their clinical latency is common. The difficulty in diagnosing these tumors and the frequent failure of complementary examinations result from their character, that is nodular, small diameter, multiple and cortical.
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Signs of glomerulopathy, especially a nephrotic syndrome can occur in cancer patients, but the exact frequency of glomerular lesions is not well known in these patients. To define this frequency in a given type of malignancy we have studied the nephrectomy kidneys in 40 patients with renal cell carcinoma. Proteinuria, which was present in 7 cases, ranged from 0.15 to 1.5 g per 24 h. Reduction of the creatinine clearance greater than 50% was observed in 5 patients. Circulating immune complexes were detected in 11 of the 15 patients studied. Carcinoembryonic antigens were noted in 2 of 9 patients investigated. Research of alpha 1 foetoprotein carried out in 12 patients was always negative. HBs antigen or Hbs antibodies were detected in 6 of 29 patients studied. Light microscopic examination of the normal uninvolved kidney tissue showed obvious glomerular lesions (mesangial hypertrophy with or without deposits, with or without cell proliferation) in 7 patients (17.5%). Amyloid deposits were never observed. Immunofluorescence study revealed mesangial deposits in 35% of patients versus 5.4% of control subjects (P less than 0.0001). These deposits included C3 and/or IgM in 13 cases, IgA and C3 in one case. No fixation was observed, neither on tubules of normal tissue nor on carcinoma lesions. This report demonstrates that glomerular deposits are usually found in approximately one third of patients with renal cell carcinoma and that these deposits are located in the mesangial areas and not in the subepithelial space as it is often observed when glomerulonephritis is expressed by clinical symptoms.
The Camey enterocystoplasty is a technique for constructing a functional, continent bladder in male patients following cystoprostatectomy for carcinoma. The technique is described and 84 patients treated during a 25-year interval are reviewed.
During a 20 month period 167 patients undergoing transurethral resection of prostate were divided into two groups: a control group without prophylactic antibiotics and a treated group who received cefotaxime 3 g intravenously perioperatively. In the first seven post-operative days 50 patients in the control group had a urinary tract infection (greater than 10(5) cfu/ml) compared with 14 patients in the treated group (P less than 0.0001). Two blood cultures were positive, both in the controls. A full course of antibiotics was administered to 55 in the control group and 14 in the treated group. On the thirtieth post-operative day 24 patients had urinary infection in the control group compared with 5 in the treated group (P less than 0.0001). We conclude that this short-term prophylaxis with cefotaxime significantly reduced the rate of urinary infection after transurethral prostatectomy.
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The authors report a series of forty patients presenting with vesicorenal reflux treated by ureteral reimplantation. Seventeen ureterorenal units were treated by Hutch's procedure, with a success rate of 75%. In 1972, this procedure was abandoned in favor of Cohen's technique, and a further forty two ureterorenal units were treated with a 90% success rate. There was no recurrence of the reflux, but there was one case of stenosis.
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We report a case of urothelial carcinoma in situ extended to the whole excreto-urinary tract and involving the prostatic gland and the papillary ducts of the kidney. The patient was followed up for almost five years. The evolution was unfavorable, as multifocal invasion appeared. We emphasize the difficulties of the pathological diagnosis on biopsy samples and relate the usual behaviour of this type of cancer who may often simulate an interstitial cystitis. Because of uncertain prognosis and difficulties in the evaluation of the disease, the optimal management for such patients remains imprecise in spite of the benefit of cytologic surveillance. Thus, in the absence of obvious invasion the choice of treatment depends at time on morphological data as well as on topographic and functional criteria.
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Angiomyolipoma should be suspected when a renal tumor is present especially when the patient is young, the tumor is bilateral, associated with hemorrhagic incidents or if there are multiple tumors in one kidney. When tuberous sclerosis is present the diagnosis is easier and when it is not, arteriography and tomodensitometry are of great help. The benign nature of these tumors is not an argument in favor of nonsurgical treatment. They may sometimes be associated with an authentic malignancy which underlines the necessity of confirming the diagnosis by peroperative examination of a frozen section. When angiomyolipoma is confirmed the surgical treatment of this benign tumor should, in our opinion, be conservative considering the frequency of bilateral disease. This approach is supported by the results published and by our own 8 cases treated by conservative surgery.
The authors used a Yag laser beam for channeling out canine prostatic adenoma (surgical or endoscopic transvesical approach) and experimental stenosis of the urethra (transperineal endoscopic route). A nitrogen flow introduced through the sheath of the fiber washed away the smoke created by the volatilization of the tissues and kept the bladder inflated at 10.15 cm H2O. The macroscopic and histologic findings immediately and 1 and 3 weeks following laser application demonstrated that the pathologic tissues were volatilized without bleeding or producing deep lesions in the neighboring areas (which were only moderated heated). The peripheric burnt area remained thin (2 cm) and precisely bordered by the intact parenchyma. The quantity of tissue removed was still insufficient but increasing the power and reducing the time of impact should improve the results.
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