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In the last 10 years we observed 75 cases of obstructive anuria: 60% during the course of pelvic cancer; 27% took place on a remaining kidney; 26% were due to kidney stones, usually uric acid stones; 3 cases were secondary to remaining kidney hydronephrosis. Diagnosis was facilitated by high dose, late film IVP and by descending uteropyelograms, one of the most reliable diagnostic techniques in trigonal obstruction. Hemodialysis was used in 10% of the cases. Early surgical treatment was often made possible by the use of spinal anesthesia.

Twenty patients with clinical acute pyelonephritis were investigated by routine CT scan. This examination was positive in 19 cases, demonstrating either a hypodense triangular image reflecting a disorder of blood supply or a mass syndrome. The CT scan can therefore confirm the diagnosis of acute pyelonephritis. It also defines the severity of the lesions and helps to guide treatment.

A case is reported in which a chronic subdural hematoma caused recurrent episodes of neurologic dysfunction that simulated transient ischemic attacks. Possible pathophysiological mechanisms are: a subdural hematoma could cause local ischemia or focal epileptic discharges; a cerebral mass could cause cortical depression by mechanical stimulation; regional cerebral edema could cause vascular displacement and ischemia; or small repeated hemorrhages could cause transient neurologic deficits. Computer assisted tomography of the head is recommended in the differentiation of the two conditions.

Elf Infertilitatpatienten mit Verschlusazoospermie wurden bei unserer klinischen Forschungsgruppe I.N.S.E.R.M. 85015 der Universitat Paris-Sud mit ihren Frauen behandelt (Urologie, I.N.S.E.R.M. U187, Gynecologie-Obstetrique, Histo-Embryo-Cytogenetique). Neun Patienten hatten langstreckige zweiseitige angeborene Misbildungen der Vasa de-ferentia und Nebenhoden; zwei andere Patienten hatten rezidivierende postoperative Verschlus-azo-ospermien.

The authors report a series of thirty A. profunda femoris dissections by anterior approach: the medio femoral way, which is enabled to isolate an arterial segment of six centimeters.

The authors recall the anatomy and embryology of the vena cava with particular emphasis on MacClure's embryological scheme which explains a number of anomalies of the vena cava and the renal veins.

Twenty one patients suffering from carcinoma of the prostate, confirmed histologically and previously untreated, received treatment in the form of 17 beta-estradiol administered percutaneously. At a dose of 6 mg of estradiol per day, testosterone levels fell to a mean of 1 ng/ml. No change in lipids, lipoproteins nor cholinesterase were detected.

Body-section roentgenograms were taken of seventy five patients examined for non-urological complaints. These were studied and the axes of the ventral and dorsal calices were measure. The axis of the ventral calix passes through the left or right colon. The axis of the dorsal calix follows the avascular line and passes to the lateral border of the paravertebral muscles, avoiding the left and right colon. These anatomical data confirm that the dorsal calix is the route of choice in the percutaneous approach to the kidney.

The authors report two cases of aortocaval fistula, resulting from the rupture of an abdominal aneurysm, and revealed by lumbar pains and hematuria. In both cases, the left kidney was mute, and was possibly responsible for the hematuria.

Serum thyroxine (T4), triiodothyronine (T3) and thyrotropin (T.S.H.) were measured in 32 hyperthyroid patients treated with carbimazole. A discrepancy between serum T4 AND T3 was present in 73 of 131 measurements: --normal T3 with increased T4 in 6 measurements; --increased T3 with normal T4 in 16 measurements: five times only there was a clinical hyperthyroidism; --normal T3 with decreased T4 in 49 measurements: three times only there was a clinical hypothyroidism. Serum T.S.H. level was increased in 13 of 19 measurements made in this group, state named "compensated hypothyroidism" according to Patel and Burger.

The authors report four cases of pregnancy in a series of 174 women who had undergone renal transplantation. In one case the pregnancy was complicated by a pre-eclamptic attack and premature delivery. A review of the literature shows that the risks to the mother and the kidney are marginal. The risk to the child, however, is more serious. Pregnancy in transplant patients is therefore a high-risk pregnancy requiring advance precautions and careful surveillance.

This article reports a case of arteriocaliceal fistula following a kidney transplant biopsy. Hematuria and anuria were arrested by therapeutic embolic occlusion.

In a population of 64 patients with cancer of the prostate, 5 of them showed thromboembolic episodes after treatment with Diethyl Stilbestrol (DES) however no thromboembolic complication in patients treated with 17 bèta oestradiol (17βE2) was observed. Predisposing factors to thromboembolism were examined in untreated patients and in the same patients separated in two randomized groups after three months of treatment with either DES or 17βE2.Before treatment no significant modifications of coagulation factors platelet count, platelet functions, anti Till, plasminogen and fibrinogen levels were observed when compared to a control population of the same age. It was also established that lipids, triglycerides (TG) and very low density lipoproteins (VLDL) were normal before treatment.After treatment, thromboembolic episodes were only observed in the group receiving DES. Although no modifications of platelets and coagulation factors were observed, a significant increase in TG and VLDL was found. In contrast in the 29 patients treated with 17βE2 no thromboembolic complication of either the coagulation profile or TG and VLDL levels was found.It is concluded therefore that the elevation of TG and VLDL was the only difference observed between patients treated with either DES or 17βE2. It is however unclear from our study how these parameters influence the coagulation process.It is proposed that other dynamic coagulation investigations have to be performed in order to assume the role of TG and VLDL predisposing factors to thromboembolism.

Cyclosporin A significantly improves patient and graft survival as compared with the conventional corticosteroid-azathioprine treatment. However, the results are the same, or even worse, when the cyclosporin A-corticosteroid regimen is compared with the corticosteroid-azathioprine-antilymphocyte globulin regimen. The authors have investigated a prednisone-azathioprine-low dose cyclosporin A combination in 46 high risk patients from a series of 117 renal transplantations performed in 1983. The actuarial patient and graft survival rates were as good as, but not better than, those obtained in 1982 in 106 patients treated with the conventional regimen which includes antilymphocyte globulin; they were 96.5% vs 98% and 85.5% vs 84% respectively at 6 months; 96.5% vs 98% and 83.5% vs 84% respectively at 12 months. The low dosage utilized (8 mg/kg instead of the usual 14-17 mg/kg) avoided virtually all the extrarenal side-effects of cyclosporin A, but not its nephrotoxicity. The theoretical risk of excessive immunosuppression was not confirmed by our study. Since cyclosporin A is very expensive, other therapeutic methods for optimal usage of that drug should be investigated.

We investigated the antitumor activity of Adriamycin on a monocytic-like cancer cell line U-937 after its binding on polymethacrylate nanospheres (diameter, 270-350 nm). Compared to free Adramycin (F-ADR), nanosphere-bound Adriamycin (B-ADR) exhibits a 3-fold enhancement of cytotoxicity, as determined by cell growth inhibition and DNA synthesis, after continuous exposure to 0.02 and 0.04 microgram/ml. The 90% growth inhibition concentration was 0.051 microgram/ml for F-ADR and was 0.018 microgram/ml for B-ADR (P less than 0.001). Furthermore, the nanosphere densities per cell play an important role since for the same drug concentration the higher the density increases, the better the activity is. Indeed, after 4 days of incubation in a medium containing 160 nanospheres at 0.5 fg/cell, the cell counts were 62.8 +/- 12.8% (SD) of the initial inoculum and they were only 16.1 +/- 0.1% after incubation in a medium containing 800 nanospheres at 0.1 fg/cell (P less than 0.001). A comparable enhancement of activity regarding the nanosphere densities was observed after a 24-h exposure to 0.02 and 0.05 microgram/ml. Short-term uptake studies showed that B-ADR accumulation was higher with B-ADR than with F-ADR. In addition, the efflux kinetics was modified. For cells exposed to F-ADR for 4 h, the efflux half-life was 23.7 +/- 7.7 h and the area to infinity under the efflux curve was 8.6 +/- 2.8 micrograms/mg protein x h-1. For cells exposed to B-ADR, the efflux half-life increased to 85.9 +/- 19.2 h and the area to infinity under the efflux curve to 29.6 +/- 6.6 micrograms/mg protein x h-1 (P less than 0.001). Electron transmission microscopy and previous findings have revealed that B-ADR was well internalized into cells. Our data support the hypothesis that B-ADR acts as an intracellular drug release complex after endocytosis. The findings regarding the number of nanospheres per cell and dose-effect relationships are consistent with mechanisms of drug actions extending to membrane domains.

Five focal non typhoid salmonellosis (NTS) are reported in a group of 342 kidney transplant recipients. There is no relationship between the unusual presentation of NTS (septicemia, pneumonia, orchitis, prostatis, urinary tract infections) and the serotypes (S. typhi-murium, S. panama). With the therapeutic immunodepression, many host factors are important to induce the unusual presentation of NTS: major surgery, urologic abnormalities, preexisting uraemic state. The major importance of decreased host resistance is emphasized by the absence of relationship between death and bacterial resistance. The use of lysotypes exclude the role of an intrahospital contamination.

The authors report fourteen cases of lymphocele in a series of one thousand consecutive renal transplantations (1.4%). The prevention of these lymphoceles depends on rigorous lymphostasis. The diagnosis is based on ultrasonography. The treatment indicated in cases of voluminous lymphoceles consisted in marsupialization and omentoplasty.

Rifampicin is considered as one of the most potent antituberculous agents and is often used in renal transplant recipients. However, acute cellular rejection episodes were observed when rifampicin was prescribed in 4 tolerant renal transplant recipients. Acute rejection occurred in 3 out of the 5 patients, despite doubled daily dose of steroids. First, rifampicin is an enzymatic inducer and accelerates steroid metabolism. Secondly, rifampicin per se is an immunosuppressive drug, as already proved in animals. Rifampicin interferes with the active mechanisms involved in specific transplantation tolerance. In conclusion, we recommend a very cautious use of rifampicin in kidney transplant recipients.

In cases of congenital absence of vas deferens (9 patients) or after failure of previous epididymovasostomy (2 patients), in vitro fertilization (IVF) was attempted with spermatozoa surgically obtained at the epididymal caput level. These sperm populations showed little progressive motility (5.9 +/- 6.5%) and an marked necrozoospermia (19.3 +/- 17.4%). Stimulation by caffeine (4.5 mM) alone or associated with heterologue normal seminal fluid resulted in most of the cases in an initiation of motility with an improvement of the progressive velocity. In 9 IVF attempts, 31 mature oocytes were inseminated with 5.10(3) to 1.5.10(6) motile spermatozoa. The dynamic characteristics in 3 inseminated sperm populations were Vp (24.2 +/- 8.3 microns/s), Ah (8.6 +/- 2.0 microns) at room temperature. Sperm binding to zona pellucida was decreased (0 to about 20 spermatozoa per oocyte) and there was no fertilization. In the same period, 21 attempts of intra uterine insemination and 14 attempts of intracervical inseminations were made in 5 couples who remained infertile after patent high epididymovasostomy (4) or vasovasostomy (1) and having immature spermatozoa stimulated as previously described. Antisperm antibodies were detected on the ejaculated spermatozoa in four men. No pregnancy was obtained with these immature stimulated spermatozoa. The fertility of the female partners was confirmed in 3 women after insemination with donor sperm.

Multiple abdominal organ procurement should enable the kidneys, the liver and the whole pancreas to be removed. Simultaneous removal of the liver and pancreas depends on arterial variations. In subjects with one single hepatic artery simultaneous removal of the liver and the whole pancreas is always possible. In subjects with right hepatic artery, the whole pancreas can only be removed if the right hepatic artery and the median hepatic artery can be left to the liver transplanter and if the coeliac trunk, the common hepatic artery, the gastroduodenal artery and the splenic artery can be preserved to feed the pancreas.

Hypothermia remains the basic principle of all organ preservation. This review shows some main cellular mechanisms involved with normo and hypothermia, particularly during ischemia. Different pathways and target sites concerned in preservation are explained. Commonly used preservation techniques and cold storage solutions are also discussed. Cryopreservation especially vitrification seems to be promising perhaps in the near future; it allows a state of almost a cellular metabolic arrest and consequently a theoretically unlimited preservation time.

Fifty-six renal artery stenoses involving transplanted kidneys among a series of 819 renal transplants performed from 1978 to 1986 were treated. Forty-two patients underwent surgery. Surgery was the initial treatment in 38 cases and followed failed or complicated dilatation in four cases. Surgical treatment ensured successful control of hypertension in 85% of cases with a mean time lag of 26 months. Recurrence rate was 12%. Two patients died in the perioperative period. Percutaneous dilatation was performed in 18 renal artery stenoses and ensured control of hypertension in 61% of cases with a mean time lag of 19.6 months and a 33% recurrence rate.

In cases of congenital absence of vas deferens (9 patients) or after failure of previous epididymovasostomy (2 patients), in vitro fertilization (IVF) was attempted with spermatozoa surgically obtained at the epididymal caput level. These sperm populations showed little progressive motility (5.9 +/- 6.5%) and an marked necrozoospermia (19.3 +/- 17.4%). Stimulation by caffeine (4.5 mM) alone or associated with heterologue normal seminal fluid resulted in most of the cases in an initiation of motility with an improvement of the progressive velocity. In 9 IVF attempts, 31 mature oocytes were inseminated with 5.10(3) to 1.5.10(6) motile spermatozoa. The dynamic characteristics in 3 inseminated sperm populations were Vp (24.2 +/- 8.3 microns/s), Ah (8.6 +/- 2.0 microns) at room temperature. Sperm binding to zona pellucida was decreased (0 to about 20 spermatozoa per oocyte) and there was no fertilization. In the same period, 21 attempts of intra uterine insemination and 14 attempts of intracervical inseminations were made in 5 couples who remained infertile after patent high epididymovasostomy (4) or vasovasostomy (1) and having immature spermatozoa stimulated as previously described. Antisperm antibodies were detected on the ejaculated spermatozoa in four men. No pregnancy was obtained with these immature stimulated spermatozoa. The fertility of the female partners was confirmed in 3 women after insemination with donor sperm.

A prospective study was conducted on 57 high-risk patients having received cadaver renal transplants between January 1983 and May 1984, and submitted to the triple combination: cyclosporine, azathioprine, and steroids. 23 patients of Group I including 12 pre-sensitized and poorly matched recipients were treated from the Day 1 post-transplant. 34 patients of Group II received the triple combination following a steroid-ALG resistant rejection. Actuarial graft survival in the whole group was 74%, 64%, and 64% at 1, 2, and 3 years respectively. Patient survival was 100% in the Group I, vs 85% at 1 year, and 82% at 2 years in the group II (p less than 0.02). The incidence of infectious complications and infectious deaths was significantly higher in patients of Group II. Our results suggest the effectiveness of a triple low-doses combination in high-risk renal transplantation, but the delayed use of this combination following a treatment with high-doses of steroids and ALG fails to reverse the rejection, with an obvious overimmunosuppression risk.