François-Xavier Wese

Pudendal cortical somatosensory evoked potentials.

To determine normal reference latencies pudendal cortical somatosensory evoked potentials were evaluated in 20 healthy volunteers. The dorsal nerve of the penis or clitoris was stimulated electrically and the cortical response was recorded from the CZ-2 point (2 cm. behind the central vertex). Reproducible responses were obtained and reference values were established.

Endoureteropyelotomy: Percutaneous Treatment of Ureteropelvic Junction Obstruction

A total of 47 percutaneous operations (endoureteropyelotomy) was performed for treatment of 41 congenital and 6 secondary cases of ureteropelvic junction obstruction between September 1983 and April 1988. Evaluation was available in 39 cases with a followup of 4 to 56 months (mean 16 months). Good results were obtained in 28 of 39 cases (72 per cent) and there were 3 failures (8 per cent). Eight patients (20 per cent) were symptomatically improved but they had residual obstruction on a diuretic study. Only 1 multioperated patient with a good early postoperative result has shown radiological deterioration at 1 year. Complications were managed conservatively, except for 1 case of intravascular coagulopathy. Endoureteropyelotomy is an effective alternative treatment for ureteropelvic junction obstruction but further evaluation definitely is warranted to define better its indications and risk factors.

Assessing the risk of unsuspected prostate cancer in patients with benign prostatic hypertrophy: a 13-year retrospective study of the incidence and natural history of T1a-T1b prostate cancers.

To determine the incidence and natural history of stage T1a‐T1b prostate cancer in patients undergoing surgery for benign prostatic hypertrophy (BPH), and thus evaluate the effect that recent medical and ‘minimally invasive’ treatments (which provide no prostate sample for pathological examination) might have on the percentage of patients with unsuspected prostate cancer.

Diverticulum formation after circular myotomy for esophageal atresia

Out of our last 70 cases of esophageal atresia, a circular myotomy of the upper pouch (Livaditis technique) was required in six patients to achieve an end-to-end anastomosis: all had a lower tracheoesophageal fistula. They were operated on between 15 and 96 hours after birth, without any preoperative attempt of elongation of the upper pouch. Follow-up ranged from 14 to 77 months. Three patients had an uneventful postoperative course and late outcome, despite a moderate ballooning at the myotomy site in one. Three babies developed a mild stricture which responded easily to a few dilatations. Asymptomatic ballooning at the myotomy site was observed in one baby; the other two developed a diverticulum responsible for acute respiratory distress in one case and severe dysphagia in the other. both required esophageal replacement. These observations call attention to the fact that patients treated by myotomy should be followed very carefully early and late, especially if an anastomotic stricture develops or in case of associated tracheomalacia.

Management of intra-abdominal organ injury following blunt abdominal trauma in children.

ObjectiveTo evaluate the strategy of a combined diagnostic and therapeutic approach in children with intra-abdominal organ injury following blunt abdominal trauma.DesignRetrospective clinical study.SettingPediatric intensive care unit of an university hospital.Patients38 children with documented intra-abdominal injury.InterventionInitial non-surgical treatment by a team of pediatric intensivists, radiologists and surgeons.Measurements and resultsPhysical examination, oriented blood and urine tests, plain abdominal film, abdominal ultrasound (US) and computed tomography (CT) with contrast. US documented intra-abdominal fluid in 30 and initial organ lesion in 14 out of 31 patients evaluated. Abdominal CT demonstrated the precise organ lesion in 34 out of 36 patients examined with solid organ lesion. Early laparotomy was needed in 7 because of severe shock, pneumoperitoneum and ruptured diaphragm, and delayed surgery in 6 patients. All 38 patients regained a normal life.ConclusionsThe stepped diagnostic approach combined with initial non-surgical treatment by a team provided accurate diagnosis and appropriate treatment. Abdominal US, by demonstrating free intra-abdominal fluid is very sensitive to detect patients with intra-abdominal organ injury, CT scan with contrast is needed to give precise information of specific organ lesions.

Urachal neuroblastoma: first case report

Abstract Tumours of the urachus are exceptional in children. They represent 0.01 % of all tumours and consist of mucosecretory adenocarcinoma and, more rarely, transitional cell carcinoma. We report a 6-month-old child with a urachal mass which, following biopsy, was shown to be a neuroblastoma.

Polyorchidism: report of three cases and further embryological considerations.

We report 3 new cases of polyorchidism. Review of the literature allows two groups of anatomical variations to be identified: (1) where the Wolffian duct is duplicated longitudinally or absent, and (2) where the two testes are drained by the same epididymis and vas deferens. We postulate that the first group results from a primary anteroposterior division of the genital ridge, whereas the second group is the result of a transverse duplication.

Do seminal or prostatic secretions play a role in local recurrence after radical prostatectomy for localized prostate cancer

Neoplastic cellular contamination of the surgical bed may be responsible for late local failure after radical prostatectomy. Cytology analysis of the seminal and prostatic fluid collected intraoperatively was undertaken in 30 patients. Neoplastic cells were found in 2 patients both with seminal vesicle involvement. Although it is difficult to admit that tumor spillage during surgery would be a major cause of local recurrence, the presence of tumor cells in the ejaculate may be diagnostic of seminal vesicle invasion. All patients with pathologic stage T2 had a negative cytologic finding.

Urachal tumor: an unusual presentation of neuroblastoma.

Neuroblastoma is the most common nonhematologic malignancy in children under the age of 5, arising from embryonic neural crest cells [1]. The most frequent anatomical sites of the primary tumor are, in decreasing order of frequency, the adrenal gland, the paravertebral retroperitoneum, the posterior mediastinum, and more rarely the pelvis and the cervical area [2]. We report here the fortuitous discovery of a neuroblastoma in a totally unexpected localization. An 8-month-old male child presented with a congenital dysplasia of the right kidney at the anatomical site detected by antenatal ultrasonography. At birth, because the clinical examination was normal, it was decided that the patient would be regularly followed up. At 7 months, in addition to the wellknown congenital dysplastic kidney, a ̄ eshy node (16 £ 15 mm) located at the dome of the bladder on the proximal portion of the urachus was detected by ultrasonography for the ® rst time. The ® rst hypothesis was a nonspeci® c congenital abnormality, possibly related to renal dysplasia, at the urachus termination site, the most common anomaly in this age at this site being urachal cyst or granuloma.

Leydig Cell Tumor: Estradiol Level at Different Locations

The authors report on estradiol levels at different locations in a patient with a Leydig cell tumor. The highest value was found in the testicular vein. The estradiol level was, however, ten times higher in the peritesticular vaginal fluid than in the peripheral veins.