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Aim: The study aimed to determine the effectiveness and tolerability of rosiglitazone, and its profile in terms of treatment adherence, treated patients and prescribing recommendations under everyday conditions of care., Methods: This was a "real-life" observational longitudinal study including patients with type 2 diabetes mellitus (T2DM) starting treatment with rosiglitazone and followed for up to 2 years. A questionnaire was completed at the time of inclusion and during routine consultations at around 6, 12, 18 and 24 months following inclusion. Information was collected on sociodemographics, clinical history, treatments, co-morbidities, laboratory data and compliance with treatment. There were three primary outcome measures: treatment response (defined as an HbA1c ≤ 8.0% or a decrease in HbA1c ≥ 0.7%); switch to insulin (as considered necessary by the physician); and occurrence of adverse events requiring a change or discontinuation of treatment., Results: The evaluation included 670 patients (61.1%) treated with rosiglitazone/metformin as fixed-dose combination tablets and 427 (38.9%) with standard rosiglitazone tablets. Rates of HbA1c response, defined as an HbA1c less than or equal to 8.0% or a decrease in HbA1c greater than or equal to 0.7%, ranged from 80.6% to 92.1% depending on the follow-up time. The percentage of patients with an HbA1c less than 7% was 18.4% before rosiglitazone was prescribed, and ranged from 48.2% to 57.8% depending on the follow-up period. Sixty-two patients (6.1%, 95% CI: 4.6-7.6%) switched to insulin therapy during the follow-up period. Spontaneously reported adverse events leading to a change or discontinuation of treatment were seen in 45 patients (4.4%, 95% CI: 3.2-5.6%)., Conclusion: Rosiglitazone showed sustained efficacy, with around 90% of patients defined as responders to the treatment in terms of reduction in HbA1c, and was relatively well tolerated. The adverse-event profile was consistent with the known effects of rosiglitazone, and no signs of increased cardiovascular ischaemic risk were observed. These results are in agreement with previous studies on rosiglitazone., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Aim: The aim of this study was to evaluate the efficacy of a continuing medical education (CME) website to improve ophthalmological management of diabetic retinopathy (DR)., Methods: A worldwide website called RETIDIAB® was created in which, to log on for first time, users had to take a preliminary test to evaluate their baseline level of knowledge. This allowed them free access to the entire website at any time with no time obligation. The website comprised a course of theoretical concepts and different types of training, including multiple-choice questionnaires (MCQ) focused on the course content, interpretation of diabetic fundus photographs and case reports. After perusing the entire RETIDIAB® website, users could take a second assessment test. Finally, they were asked to fill in a questionnaire evaluating the entire programme., Results: A total of 137 users were registered and, of these, 109 took only the preliminary test, while 28 took the second test and evaluated the entire website; of the latter, 75% were residents and 25% were practising physicians, and 15 were male and 13 were female, ranging in age from 26 to 42 (30.2 ± 3) years. Statistically significant progress was seen between the first and second evaluations (37.3 ± 14% correct answers vs 64 ± 10%, respectively), and the average time interval between the first and second evaluations was 40 ± 20 days. In addition, users expressed a high level of overall satisfaction with the site., Conclusion: This pilot study demonstrated the value and effectiveness of RETIDIAB®, a new CME website exclusively devoted to DR management., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of this observational study was to evaluate the screening for diabetic retinopathy (DR) using eye fundus photography taken by a nonmydriatic camera and transmitted trough the Internet to an ophthalmological reading centre, as compared to a dilated eye examination performed by an ophthalmologist., Methods: A total of 456 and 426 diabetic patients were included by two different groups of primary care physicians (PCPs), 358 being screened with the non-mydriatic camera (experimental group) and 320 with dilated eye fundus exam (control group)., Results: The proportion of screened patients for whom PCPs received a screening report within the 6-month follow-up period was 74,1% for the experimental group and 71,5% for the control group. Screening for DR was negative in 77,6% of patients with eye fundus photographs vs 89,6% with dilated eye examination. DR was diagnosed in 62 patients (17,3%) with eye fundus photographs versus 31 with dilated eye examination (10,4%). Referral to an ophthalmologist was required in 59 reports of patients with photographs (16.5%), 23 of them due to high grade DR. Finally, the non-mydriatic camera was found of little inconvenience by patients., Conclusion: The telemedical approach to DR screening proved to be effective in providing primary care practitioners with information about their patient's eye status. This screening method allowed to identify patients requiring prompt referral to the ophthalmologist for further complete eye examination. In conclusion, this study provided successful results of DR screening using fundus photography in primary care patients, and strongly supports the need to further extend this screening program in a larger number of French sites.

Objectives: Diabetic retinopathy (DR) remains a major cause of visual impairment in France, due to insufficient regular annual screening. Fundus photography is a sensitive alternative to ophthalmoscopy for DR screening. The aim of our study was to report the first telemedical approach to this screening in a primary care setting in France., Methods: A DR screening centre equipped with a nonmydriatic camera was opened in the 18th district of northern Paris and placed at the disposal of general practitioners (GPs) of the Réseau de Santé Paris Nord (North Paris Health Network). These GPs were invited to send their diabetic patients who had no known DR and had had no fundus examination for more than one year to this screening center. Retinal photographs were taken by an orthoptist without pupillary dilation and sent for grading through the Internet to the Lariboisière Hopital Ophthalmology Department., Results: During an 18-month period, 912 DR screening examinations were performed in 868 diabetic patients referred to the DR screening center by 240 GPs. Patients' mean +/- SD age was 59.9 +/- 11.1 years. Of these 868 patients, 260 (30%) said they never have had an ophthalmological examination. Diabetic retinopathy was detected in 197 patients (22.7%). The proportion of patients for whom fundus photographs of one or both eyes could not be assessed was 10.1%. 159 patients (18.3%) required referral to an ophthalmologist., Conclusion: Nonmydriatic photography, combined with teletransmission to a reading centre, proved to be a feasible valid method for the detection of DR. This screening method allowed the identification of patients requiring prompt referral to an ophthalmologist for further complete eye examination.

Occurrence of mucinous tumors is favored by Peutz-Jeghers syndrome (PJS). A case of bilateral ovarian mucinous tumor associated with ovarian mature teratoma occurring in a 22-year-old woman with PJS was reported. Tumor cells included 5 cell types: tall columnar mucinous pale cells with neutral mucins; goblet cells with acidic nonsulfated mucins; non mucinous columnar cells; mucinous cuboidal cells lining small glands; endocrine cells. Expression of the MUC2, MUC3, MUC5AC and MUC6 genes was demonstrated by in situ hybridization according to cell type. Some atypia and numerous mitotic figures were observed in basal glands. Diagnosis was ovarian borderline mucinous tumor with gastric and intestinal phenotype associated with PJS.

The authors have done a prospective non randomized study to compare two methods of radical retropubic prostatectomy, without bladder neck preservation (Group 1 = 30 patients) or with bladder neck preservation (Group 2 = 15 patients). Anastomosis was simplified for the 15 patients with bladder neck preservation according to the Vest suture procedure. A comparative urodynamical study was performed with each group. Selection for one or the other technique was made by the personal choice or every surgeon. Results were similar for pre operative clinical staging, Gleason score with both groups. There was no significant difference in survival, progression of the disease and three month PSA level as those of the last follow-up visit (18-96 months). There was no difference between the 2 groups regarding operative time, blood loss, urethral catheterization time, drainage output and mean hospitalisation time. The only significant difference was the number of post operative transfused blood units in the Vest suture group (p < 0.001). There were no positive margin on the preserved bladder neck in group 2, even if there was finally an understaging or another apical positive margins. Complications were not significantly different in the two groups with 10 bladder neck strictures in the group 1 (33%) and only 2 in the group 2 (14.2%) (NS). Complete continence rate was 73.3% and 64.2% respectively (NS). Bladder neck incision was never followed by incontinence. On urodynamical study, 9 cases in each group were compared and both were similar but there was a tendency to a higher urethral pressure in group 2. Comments pointed out that bladder neck preservation and simplified Vest traction suture did not give more post operative nor carcinological complications than classical technique with direct separate stitches sutures. Disease progression, continence and bladder neck stricture rates were compared to literature. The urodynamical results were the same as those observed by others studies.

One hundred and ninety nine patients complaining of genuine stress incontinence not previously treated underwent Burch colposuspension. The operation has been either isolated (42.2%) or associated to a vaginal repair (36.2%) or associated to a vaginal repair and a sacral hysteropexy (21.6%). No serious operative complication occurred. The overall rate of postoperative complications was of 14% without significant difference between the surgical procedures. The overall clinical cure rate for stress incontinence was 90%. The rate of failure was significantly higher when the Burch operation was performed alone. The failures were revealed mostly in the six first months, confirming the stability of the results (20 months average follow-up). The present data confirms that Burch colposuspension is effective in stress urinary incontinence. The authors recommend a systematic association to a vaginal repair and, in case of bladder descent, to a sacral hysteropexy.

Regarding a case of little-differentiated adenocarcinoma of prostate in a 79-year old male patient undergoing antiandrogenic corticosteroid therapy (cyproterone acetate), the authors describe a rare complication related to treatment with the drug. Cytolytic icterus, without cholestasis, occurred eleven weeks after starting the treatment without metastasis of the primary cancerous lesion, and regressed when administration of the antiandrogenic agent was interrupted. This description is compatible with toxic hepatitis. This is a rare complication, which should be differentiated from stasis icterus consecutive to treatment with progestogens. Its diagnosis precludes also primary or drug-induced secondary tumors or degenerative hepatic lesions. A knowledge of this complication by the urologist is important, so the latter might not conclude too hastily to metastatic extension of primary cancer of prostate. Withdrawal of the patient from antiandrogenic therapy is mandatory, and management should incorporate complete biological investigation of liver function, CT scans and, depending upon the case, liver biopsy as the only means of studying this exceptionally rare complication.

On the basis of a series of 9 patients (12 renal units) gathered over 19 years, the authors analyze the current possibilities of treatment of cystine lithiasis. They first describe the characteristics of this litiasis, which is rare but serious, being naturally prone to recurrence because it is caused by a genetic defect. The development of extracorporeal lithotripsy raised great hopes for the treatment of this lithiasis, but it was soon realized that cystine strones were hard to break. However, even the mere fragmentation of the stones improves the dissolving action of the various drugs proposed to modify the pH of urine. The authors consider that open surgery by means of posterior vertical lumbar section still is indicated for larger stones, and percutaneous nephrolithotomy seems to be a very useful technique, either exclusively or as a complement of extracorporeal lithotrity.

On the basis of a retrospective series of 74 patients with adenocarcinoma of the prostate, the authors study the survival of these patients according to the clinical stage of the lesion when treated with cyproterone acetate. Biologically speaking, the authors have studied the evolution of the blood testosterone level, as well as of PSA and PAPs. Their conclusion is that the PSA is an excellent indicator of the efficacy of the cyproterone acetate treatment. Its fast decrease proves treatment efficacy, while a new rise indicates the resumption of evolution of the neoplastic process and must lead to change the therapeutic approach.

On the basis of a series of 62 files gathered over 18 years, the authors study vesicorenal reflux in duplication of the ureters. The abnormally was bilateral in 10 cases, and a total of 206 ureters was analyzed. Clinically, fever and a urinary infection are the usual expression. While intravenous pyelography allows assessing the condition of the upper urinary tract, retrograde cystography demonstrates the reflux and indicates its degree. This study confirms that the reflux mainly occurs in the lower pelvis and that it is very marked (stage II + stage III = 62.9%). Three categories of patients should be distinguished: infants younger than age 2; children from age 2 to age 15; and adults. Purely medical treatment was disappointing, and surgery seems to by far the best solution. However, the solution is different according to whether or not another malformation is associated with duplication and reflux. In the latter case, the surgical procedure is simple, while in the former there often is a complex pathology which sometimes raises difficult surgical problems, especially in children.

On the basis of 133 cases, the authors analyse the clinical features and the modalities of the treatment of vesicorenal reflux in children under age 2. The number of girls is higher than that of boys. The diagnosis is most often established between 0 and 6 months of age, with a very marked peak between 0 and 1 month. The usual warning sign is a urinary infection with fever. Pyerography is normal in every second case, and retrograde cystography is the key examination, which confirms the reflux and establishes its side and degree (bilateral reflux in 53% of cases, stage II in 48% of cases). 33 children were operated at once. Another 100 first had a medical treatment, ie. urinary antibiotics, on the basis of strict criteria that are listed here. This medical treatment has been very disappointing: 20 children were lost to follow-up and 47 had secondary surgery. When surgery is necessary, advancing plasty according to Cohen's procedure yields excellent results: 98.6% of 76 operations were successful. The authors therefore think that Cohen's procedure is widely indicated, even in children under age 2.

Despite the very good results published by B. Barrat Boyes and A. castaneda with early correction of Tetralogy of Fallot in the first year of life, the authors prefer palliative surgery for this group. They have operated upon 47 infants less than one year of age, 15 of them being less than 2 weeks of age. The overall mortality is 4%, the only two deaths being in the neonate group, which is usually a very small group in the published series with early correction. Since all the children with S.P. Shunt performed for Tetralogy of Fallot can wait 2 to 4 years before complete correction, and since the mortality of corrective surgery at 4 years of age is almost nil, the authors think that the two stages approach give as good results than one stage surgery, despite the possibility of neurological complications which may occur between operations. They argue that with early correction, surgeons are obliged to put more transannular patches which result in more pulmonary insufficiency cases, and that the mortality in this age group is still very high in some publications. They have also compared the percentage of low cardiac output syndrome after correction and found that children with a previous S-P shunt have smoother post-operative course. Finally they think that it is possible to obtain a global mortality around 7% for the 2 stages approach and that this kind of surgery is technically easier than early correction and must be very useful for the majority of cardiac centers interested in congenital heart disease.

Principal technical features are described briefly based on a personal series of use of the procedure in 35 cases. The patient is placed in decubitus; a parietal approach is performed while avoiding the genitofemoral nerve; the incision can be enlarged downwards and above all upwards (subperiosteal segmental resection of 12th rib). The lateral posterior vertical lumbotomy possesses the advantage over classical lateral lumbotomy of being less disturbing to muscle, being less painful postoperatively, and never leading to eventration. It also reduces hospital stay. It presents the disadvantage, however, of providing only a narrow view of the operation zone, which limits its use to simple procedures such as exeresis of pyelic and upper lumbar ureteral calculi. It is dangerous, on the contrary, and should not be used in surgery of coralliform stones.

On the basis of three cases, the authors study the problem of perineal urinary fistula secondary to rectal surgery. They first note that little attention has been devoted to these lesions. The clinical and radiological features are described and analysed, in a pathological context. Treatment of these fistulae is difficult if a conservative approach is sought, and the best solution is perhaps nephrectomy or bypass by a Bricker operation carried out either initially or after an attempt at repair has failed.

In a 6 cases report of stones developed in horseshoe kidney in children, from 25 months old to 14 years old, diagnosis and surgical problems are analysed. Another urological malformations have to be researched mainly vesico renal reflux and pyelo ureteric junction obstruction. Diagnosis is usually made when stones give complications where septic obstruction is not rare and can be severe in children. Pre and intra-operative sonography can currently do the stone localisation. Surgical management of stones developed in horseshoe kidney seems to be done still by open surgery because new techniques as Eswl or percutaneous lithotripsy can be difficult to perform or dangerous in children on this malformation. Number of operations can often be higher than in adults, to do both treatment of the stone and associated malformation as PUJ obstruction, mainly if there are infected and septic complications.

The authors, after personally observing three cases, review the literature on breast cancers in patients with prostatic cancer treated by estrogens. The authors' three cases are all metastatic breast cancers, and one has also a renal cancer. These three cases are added to the 22 reported in the literature which include 13 metastatic cancers, 6 primary breast cancers, and 3 cancers of unspecified nature. The seriousness of these breast involvements is obvious when they are a manifestation of tumor dissemination. The authors discuss the possible responsibility of the estrogen therapy in the development of the breast cancer. The downhill course and the appearance of breast cancer with generalized dissemination evinces an important decrease in the patient's immunity which allows metastases and multiple tumors to occur.

The author reports 4 cases of severe delayed irradiation complications which required partial or complete secondary amputation of the penis for sequelae of local therapy with Iridium. After reviewing the modes of spread of carcinoma of the penis and the various therapeutic possibilities in the light of these 4 cases, the author raises the question as to whether such conservative treatment by interstitial radiotherapy is well-founded. He would tend to suggest immediate surgery giving an identical result at the price of much shorter treatment and which would be free of the complications reported following radiotherapy.

Many methods exist for repair of anterior penile hypospadias but one of the most commonly used is certainly Mathieu's operation. However, this procedure can give rise to different complications due essentially to necrosis of a cutaneous flap brought anteriorly to reconstitute the missing portion of urethra. Based on the pedunculated cutaneous flap described by Blandy for use in urethral shortening, a proposal is made to obtain the flap for canal reconstruction laterally, this allowing conservation of its total vascularization and thus avoiding the risk of ischemic necrosis.

Solid, intra renal tumors of children and infants are in most cases nephroblastomas. All the other types of solid tumors, malignant or benign, are very rare. This observation seems to be the seventh case of intra renal teratoma in the literature. The entire upper pole of the left kidney had disappeared, being occupied by a large tumor which proved to be solid upon specific examinations. Anatomo-pathologic examination, following nephrectomy, proved it to be benign.

Two patients presented parotid metastases from adenocarcinoma of kidney. These metastases are rare and may reveal or develop during the course of a cancer of kidney. In the former case diagnosis presents certain difficulties. Treatment of single metastases is by parotidectomy and nephrectomy, prognosis being similar to that of the renal adenocarcinoma.

Thrombo-embolic complications remain one of major preoccupations of surgery. As well as their treatment, prevention is of even greater importance. Following a discussion of the physiopathology of coagulation in the patient undergoing surgery, the authors study those factors peculiar to urology. Despite the risk of haemorrhage involved in such surgery, 158 patients underwent operation after having received anticoagulants in the form of sub-cutaneous calcium heparinate even before the procedure. The decrease in the number of thrombo-embolic complications appeared to confirm the effectiveness of this therapeutic measure.

Based on the personal observation of two cases and a series of 40 patients reported in the literature, the specific problems related to injuries to horseshoe kidney are evoked. The first case involved crushing of the isthmus against the spine recognized at operation on the 5th day and suggested by urography, CT scan and arteriography data. Abstention from surgery in the second case was decided on initial urography and ultrasound findings and the rapid, spontaneously favorable course. A literature review failed to provide much original data related to the anatomical anomaly, too frequently detected during emergency surgery. The only particularity is related to rupture of isthmus which may damage upper excretory pathways; this explains the interest for the authors of pyelostomy in case of conservative surgery in this context. When surgery is indicated this should be reserved to severe forms and postponed. It is important to carry out arteriography in addition to urography and a CT scan because of the particularity of the vascularization of this type of kidney: the anterior transperitoneal approach appears to be the best adapted.

On the basis of a case of partial nephrectomy of a single functioning kidney performed with immediate success in a 77-year-old woman, the author reviews the main data from the literature concerning this particular treatment of carcinoma of the kidney. In the great majority of cases the carcinoma required partial nephrectomy only because the affected kidney was single. Operative mortality was low : 2.6 %. Three year survival is 61 % of cases and it is important to note that terminal renal failure and recurrences in the remaining portion of the kidney are rare. Metastases represent the chief cause of death. Survivals ranging from 6 to 14 years have been reported. When the fact that the kidney is single is not because of nephrectomy for a carcinoma, the prognosis after partial nephrectomy is the same as that after wide excision for carcinoma (in patients with both kidneys). When the opposite kidney had been the site of a carcinoma and even more so in the presence of metastases, the prognosis becomes far less good. With a single kidney, the development of a carcinoma does not necessarily imply the need for total excision of the kidney followed by intermittent haemodialysis. A partial nephrectomy is worth the attempt when it appears to be reasonable. A number of particular technical features are emphasised : - the need for prior arteriography which defines the respective topography of the tumour and the renal vessels, - the safety of temporary clamping of the renal artery when the kidney is made hypothermic by cooling using ice piled up in contact with the kidney, - the possibility of performing such an excision in situ via an appropriate surgical approach.

A great many approaches have been suggested to stop the very pronounced hematuria which on occasion complicates bladder tumors and radiocystitis or drug induced cystitis. Some clinicians have recommended instilling diluted formol in the bladder. The writers report on their impressions of this method based on experience with three cases. They elucidate possible procedural guidelines taking into account various intervening complications.

The authors report a series of 190 surgically treated cases of ectopic testicles. After comparable dissection in the two different groups, two different types of fixation were used. In the 66% where the testicle was fixed in traction, Leveuf method, there were 17% failures, whereas with the "in-dartos" method there were only 4% recurrence. In analyzing the failures in each group the authors stress the importance of the character of the operation. The majority of the failures are in the cases of highly placed abdominal testicles, and in those needing a certain amount of traction. However, the difference in results of the two groups is so striking that the authors find the "in-dartos" method definitely superior to the Leveuf method, when used in comparable cases.

The authors report 2 cases of a condition often overlooked by the urologist: incrusted cystitis. It shows up clinically with severe urinary troubles and bladder calcifications. In fact the main finding is calcified plaques in the mucosa causing an inflammatory reaction and mimicking a tumor. Histologic examination of endoscopic biopsies rules out tumor and reveals a calcified necrotic mucosa. A high degree of alkalinity of the urine makes the diagnosis of incrusted cystitis after ruling out tuberculosis and bilharziasis. Acidifying the urine clears up the trouble and brings the bladder mucosa back to normal. According to the literature, 3 factors are necessary for the development of incrusted cystitis: a ureolytic microbe capable of releasing ammonia, alkalinity of the urine resulting from this, and a bladder with lesions of cystitis whatever might be the cause. A number of diagnostic errors are possible, but the most serious one is mistaking it for a calcified malignant tumor of the bladder. For this a biopsy is essential to prove the absence of a tumor. The treatment consists of 3 stages: excision of the calcified plaques (mostly by endoscopy), sterilization of the urine (nalidixic acid would be the best agent) and acidification of the urine.

The authors emphasise the value of bilateral posterior iliac oestotomy in facilitating aponeurotic and cutaneous closure of ectopia vesicae. The osteotomy cuts the wing of the iliac bone above the greater sciatic notch 2 cms lateral to the sacroiliac joint. The new point made by the author is the use of an external fixation device the pins of which are implanted only in the iliac crest in the still young child, whilst in the adolescent a more solid method of fixation involves in insertion of additional pins in the pubis (taking care to avoid the femoral vessels). The recommended operative schedule is as follows: 1) Simple posterior iliac osteotomy. 2) Bed rest for 8 to 15 days until cutaneous healing of the iliac incisions. 3) Urological phase (which for the author consists of excision of the plaque with ureterocolic implantation) with aponeurotic closure (using eliptical strips fashioned from the rectus sheath) and simple cutaneous closure without any traction because of the osteotomies. 4) Insertion of external fixation device at the end of the urological phase. This is supported by 2 cases reports with and uncomplicated postoperative course from both a urological and orthopaedic standpoint.

Of 18 cases of embryonic carcinoma seen over the last 13 years, 10 were classified as inferior to stage III and were treated without glandular curettage: 5 by combined chemotherapy and radiotherapy, 3 by chemotherapy alone and 2 by radiotherapy alone. All patients have survived beyond 2 years (2 to 11 years). The attitude is considered as too restrictive which implies treating only when secondary recurrence occurs, since certain patients are lost to view. Moreover, curettage has a higher morbidity than chemotherapy. Routine chemotherapy without glandular curettage would appear to be indicated for stages a priori I and II.

Amongst infective lesions of the kidney, xanthogranulomatous pyelonephritis has a place of its own. Whilst some consider it to be a distinct entity, others classify it within the broad group of the pyonephroses. From a clinical standpoint, lithiasis is common and urinary infection quasiconstant. Radiological appearances and the therapeutic approach differ according to whether it is, as is most common, a generalised form or the much rarer localised form. On the basis of 3 cases, the authors review the principal features of this curious condition.

Four patients presented isolated angiomyolipomas of kidney in the absence of any form of phakomatosis such as Bourneville's disease. The tumor was removed by partial nephrectomy in only one case, after histology of a fresh specimen confirming the presence of an angiomyolipoma without signs of cancer. In another patient it was impossible to perform conservative surgery because of dissemination of the angiomyolipoma throughout the kidney. Symptomatology suggestive of the disorder includes lumbar pain, kidney tumor and more rarely hematuria. Diagnosis is difficult despite availability of ultrasound and CT scan imaging, which has supplanted renal arteriography. Confirmation requires histology of a fresh specimen. Operative treatment is essential to avoid the risk of intra- and peri-tumoral hemorrhage, particularly during pregnancy. Partial nephrectomy or excision of tumor is possible when the diagnosis has been established, if excision involves healthy parenchyma and if after strict hemostasis at least one third of renal parenchyma remains.

Since 1960, cyclophosphamide has been widely used in the treatment of solid malignant tumors, certain hematological and systemic diseases and indeed even in renal transplantation. However, while the efficacy of the product is certain, it became rapidly apparent that this molecule had a definite toxicity for urinary endothelium, in particular that of the bladder. This toxicity is due to certain metabolites of the molecule and to the fact that urine stagnates in the bladder reservoir. It is manifested principally by hemorrhagic cystitis which is always difficult to treat and which is sometimes life threatening for the patient. However, cyclophosphamide can also induce malignant bladder tumors with a poor prognosis. Since 1971, 56 cases of bladder cancer due to cyclophosphamide have been published. It is therefore a rare lesion generally manifesting itself by hematuria and sometimes occurring a long time after discontinuation of treatment. At the time of first examination, 2/3 of these tumors were widely infiltrating and despite major surgery (50% of cases required immediate total cystectomy) the prognosis was very poor due to the fact that the bladder cancer added its own degree of gravity to that of the initial disease which justified the introduction of treatment. All the authors who have studied this problem therefore stress the necessity of avoiding cyclophosphamide when another molecule may be effective and especially when it is not a malignant condition which is being considered.

On the occasion of four cases, the authors studied the problems posed by traumatic rupture of the urethra in boys. They draw a very clear distinction between fresh rupture where the urethral lesions are only one of the elements of multiple trauma. The clinical picture and the I.V.P. form the basis for the diagnosis, and the indwelling catheter when it can be placed in position remains a valid mode of treatment. At the stage where complications have arisen, a clinical as well as a radiological check-up is indispensable before taking any decision. If action must be taken, suture-resection seems to be the best solution.

The authors sought to assess the efficacy and tolerance of a new oral form of nalidixic acid in the treatment of infections encountered in urological surgery. The study was based upon 30 cases. The urine was considered to be infected when more than 10(5)/ml organisms were present. Amongst 27 patients undergoing surgery, in 26 cases the operation was an endo-cavitary procedure involving the upper or lower urinary tract. The 3 non-surgical cases consisted of one patient with cystitis and two with prostatitis. In 6 patients, treatment was preventive, the urine being sterile before urological surgery. In the other 24, infection was present at the time that treatment was begun. E. coli present in 20 patients was the predominant organism in the series. Tolerance of treatment was perfect in 27 cases. In the 6 cases of preventive treatment, prescription of the drug prevented a postoperative infection. In the 24 patients receiving curative treatment, there were 7 failures (29%) and 3 late recurrences (12.5%). Failures were all the more frequent when the dose was lower. The authors equally felt that the prescription of 4 grams per day in one case was unsuitable. Organisms isolated when treatment was seen to have failed were all resistant to nalidixic acid. In the context of urological surgery, where there is often a cause of reinfection (catheters), the prescription of a high dose of the drug is an essential factor in decreasing the risk factor inherent in treatment.

Mature ganglioneuroma, a benign nervous tumor of sympathetic origin, is an uncommon diagnosis in adults, particularly when it is located in the retroperitoneal region. Embryology provides an explanation for detection of this tumor in the adrenal glands. The fortuitous discovery of a lesion of this type in a patient with a homolateral renal adenocarcinoma provoked diagnostic and therapeutic problems that are discussed and analyzed.

A 23 year old man, expert in karate, complained of sudden movements of right hip during "circular kicks", followed by persistent pain. Arthrography showed synovial plication in joint at upper border femoral neck, with a tongue-like projection from upper recess extending to head/neck junction and provoking bone erosion visible on standard images. Recovery followed resection of the fold. This is probably the first case of this type to be published. The lesion recalls the internal synovial plica of knee but differs from "frenula capsulae" and does not appear to have been described by anatomists. As in the knee it is probably an embryonic relic.