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Biomedical subjects

S Zmerli

Publications and source records attributed to S Zmerli.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Reparation of sequelae of penile-scrotal and perineal gangrene. Apropos of 4 cases].

The authors report different techniques for surgical reconstruction of the sequelae of penile, scrotal and perineal gangrene. The repair of skin defects and the reconstruction of the scrotum requested several interventions. Where the scrotal skin loss was limited to a 1/2 of scrotum, the testis could be covered by mobilising the surrounding rim. When the disease was confined to the penis or inguinal region, skin cover has been provided by free grafts. More elaborate techniques of skin cover were necessary when the disease was extended to the whole scrotum: a fasciocutaneous flap from the thigh was used for reconstruction of the scrotum. The scrotal myocutaneous flap was used to cover skin and anterior urethral loss of tissue.

Adult↗
PubMed1989

[Primary adenocarcinoma of the bladder. Apropos of 10 cases. Retrospective study].

We report ten clinicopathological cases of primary adenocarcinoma of the urinary bladder. Histologic features were often reminiscent of those seen in digestive tumors: Lieberkühnian adenocarcinoma (4 cases), mucinous adenocarcinoma (3 cases) and signet ring cell adenocarcinoma with linitis plastica (1 case). Prognosis was poor in these tumors that were all invasive and had spread beyond the muscular layer: four patients died and six were critically ill when they were lost to follow-up. We emphasize the role played by glandular metaplasia of the vesical urothelium in the histogenesis of these tumors.

Adenocarcinoma↗
PubMed1989

[Uretero-vaginal fistula. Apropos of 30 cases].

The authors report 30 cases of uretero-vaginal fistulae collected in the department of Urology at Charles Nicolle's Hospital in Tunis. The majority of patients are multipare between 28 and 47 years old. The main causes remain gynecological and obstetrical procedures. The main motive of consultation was leaking of urine from the vagina; unfortunately the attendance to our clinic was late. IVP was performed in all cases; in 22 cases it showed a dilatation of the ureter, pelvis and calyces, on one side; in 3 cases it showed a non functional kidney and in 5 cases it was normal. Retrograde uretero-pyelography was performed for seven patients, twice in case of non functional kidney and five times after a normal IVP. In all cases it showed extravasation of contrast medium at the level of the fistula and the proximal portion of the ureter was not opacified. Treatment was by: reimplantation of the ureter in the bladder in 21 cases; end to end ureteric anastomosis in 5 cases; nephrectomy in 3 cases; in one case the fistulae healed by drainage. Control IVP was performed after a while and showed: success of the procedure in 15 cases; no change in 4 cases; an affected kidney in one case. Unfortunately diagnosis is never made at the time of surgery and this underlines the absolute necessity to check the ureter if there is any doubt about its integrity. In case of post operative complications it is important to request an IVP as soon as possible. In large fistulae reimplantation of the ureter by the Leadbetter-Politano technique, with fixation of the bladder to the psoas muscle, gave the best result in our hands. Postoperative follow up is necessary to detect any stenosis or reflux.

Adult↗
PubMed1989

[Pelvic kidney. Apropos of 50 cases].

The pelvic ectopic kidney is a relatively rare congenital anomaly. It is situated below the horizontal level of the iliac crest. Fifty cases, collected over twelve years, are reported here: 47 unilateral PEK, 2 bilateral PEK, 1 solitary PEK. The main clinical patterns are outlined. The healthy ectopic kidney (18 cases): clinical complaints are derived from adjacent organs. The diseased ectopic kidney (32 cases). Urinary symptoms reveal the anomaly. Renal stones (21 cases) and uretero-pelvic junction disease (7 cases) are the most frequent lesions encountered. The diagnosis is based on IVP data. Ultrasonography and computed tomography are of great help: they avoid useless and expensive complementary investigations when clinical symptoms are misleading. Ectopic kidney should be treated as if it were in its normal position. However, surgical procedures that may be performed might be particularly difficult because of different anatomical environment and non-systematized blood supply.

Adolescent↗
PubMed1989

[Iatrogenic urethral stenosis. Apropos of 100 cases].

Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care.

Adolescent↗
PubMed1989

[Retroperitoneal lymphangioleiomyoma. Apropos of a new case].

A new case of particular retroperitoneal lymphangioleiomyoma in a 56 year-old man is reported here. All cases reported to date have occurred in females. The mass was removed and the diagnosis was made by histopathology. The prognosis of localized retroperitoneal lymphangiomyoma is good. Diverse modes of therapy have been applied for lymphangiomyomatosis which multiple prognosis is doubtful.

Humans↗
PubMed1989

[Vesico-uterine fistula. Apropos of 5 cases].

Five cases of VUF have been observed by the authors over a period of 15 years, reflecting the rarity of this condition. Based on a review of the literature, the authors present an exhaustive study of the various aspects of VUF: 1) aetiopathogenic features: they emphasise the rarity of the disease and its aetiology which is currently dominated by caesarean section; 2) clinical features with little variability in the symptoms (urine leak from the vagina with or without associated menouria) and the usually simple diagnosis based on a thorough clinical examination and routine complementary investigations (IVP, cystography...); 3) lastly the therapeutic aspects, based on surgical cure, which is almost always satisfactory. On the basis of their experience and their results, VUF constitutes a benign lesion, but a source of discomfort, which should be prevented.

Adult↗
PubMed1989

[Genitourinary malacoplakia. Apropos of 5 cases. A review of the literature].

The authors report 5 new cases of malakoplakia: 2 with kidney, 1 with prostatic and 2 with testicular involvement. The symptoms are not clinically specific, but pseudo-tumor forms are predominant. Four cases were treated by removal of the organ. Owing to a better understanding of its etiopathogenic mechanism, this disease can be treated by long-term antibiotic, cholinergic agonists and vitamin C therapy.

Aged↗
PubMed1989

[Idiopathic retroperitoneal fibrosis in children. Apropos of a case, review of the literature].

A case of idiopathic retroperitoneal fibrosis (IRF) in an 14 year old boy is presented. The diagnosis was mislead by the pelvic localization. One year after the biopsy and without any treatment, the scanner control shows the regression of the fibrotic plaque. The authors review the literature of this condition. They recall the principal clinic features of IRF in the children. A discussion of current diagnostic procedures and treatment is presented.

Adolescent↗
PubMed1989

[Pheochromocytomas].

A retrospective study of 24 pheochromocytomas observed between 1974 and 1987 is reported. Hypertension is the most frequent sign. In 19 cases diagnosis of pheochromocytoma was confirmed by surgery. In 3 cases, preoperative diagnosis was "silent" adrenal tumor. Two had exploratory surgery for renal artery stenosis and renal tumor. Diagnostic strategy and its evolution with high sensitivity biochemical examinations and computed tomography was analysed.

Adolescent↗
PubMed1989

[Asymptomatic tumors of the adrenal glands. Apropos of 5 cases].

Five "silent" adrenal tumors were reported. 3 of them were very large. Excision of tumor was enlarged to adjacent organs in 3 cases. On palpation a mass was felt in three cases, and in two cases the mass was accidentally discovered by ultrasound. Operation was performed with the diagnosis of adrenal mass in four cases. Microscopic examination revealed the tumor to be pheochromocytoma in 3 cases and adrenal cortex mass in two cases. Malignancy is confirmed from metastasis. Treatment was only surgical. Since no reliable preoperative investigations are yet available to assess the nature of adrenal masses, their surgical excision is indicated for microscopic examination.

Adrenal Cortex Neoplasms↗
PubMed1989

[Complete bladder retention secondary to a herpetic genital infection. Report of a case. Review of the literature].

The authors report their experience of acute urinary retention due to genital herpetic infection. The data gathered by physical examination and laboratory investigations are of great diagnostic value. The urodynamic investigation provides a better comprehension of the pathogenesis of the phenomena. Bladder drainage is urgent. Complete resolution within a few days to three weeks is the general rule.

Adult↗
PubMed1989

[Retroperitoneal fibrosis. Apropos of 12 cases. Retrospective study].

Twelve patients with idiopathic retroperitoneal fibrosis, between 1973 and 1988 are reviewed. Their mean age at presentation was 41 years. The different and particularly confusing clinical manifestations (ejaculation disorders, pelvic or abdominal or abdominal mass) are discussed. The diagnosis, which was based on pyelography and retrograde pyelography, is now established much more clearly by means of ultrasound examination and CT scan. In case of diagnostic problems, ultrasound or scan guided fine needle biopsy can direct the diagnosis. However, the definitive diagnosis can only be determined by means of surgical exploration and biopsies, which were necessary in four cases. Surgical exploration was followed by surgical ureterolysis in two cases. In four cases, treatment was with corticosteroid therapy only. Five patients were treated by ureterolysis and steroid therapy. Spontaneous remission after biopsy in one case and ureterolysis alone in an another case has been followed by CT scan with a mean follow-up of 24 months. Results were satisfactory in 20 on 22 ureters treated by corticotherapy alone, surgery alone or both operation and steroid treatment with a mean follow-up of 56 months.

Adolescent↗
PubMed1989

[Disease of the pyelo-ureteral junction in adults. 215 cases in 194 patients].

215 uretero-pelvic obstruction syndrome among 194 adult patients are analysed. 56.8% of them are of stage III or IV. Lithiasis is a frequent complication (41.8% of cases). The other congenital anomalies are very rare. The diagnosis is based on intravenous pyelography with use of furosemide test when the obstruction is moderate. 178 uretero-pelvic plasties are performed, the resection-anastomosis has retrained our choice. It was done in 119 cases with good results in 85.6 cases. Failure are due to error of indication or technical defect. The high level of nephrectomies (25%) is explained by the very important number of advanced and complicated cases. Among the less symptomatic patients, 37 haven't been operated on and were controlled. All except one remained stable.

Adolescent↗