Diagnosis and management of posterior urethra disruptions

Rupture of posterior urethra is usually seen in major traumas with associated pelvic fractures. Clinical presentation classically associates blood at the uretral meatus and urinary retention. Urinary diversion should be achieved by suprapubic puncture and major associated traumatic injuries (abdominal, orthopaedic, and neurological lesions) must be treated prior to urological management. Retrograde uretrocystography is performed a few days later in order to localize and classify the urethral lesion. Treatment of posterior urethral ruptures has evolved over the years. Immediate open repair is no longer recommended. The supra-pubic catheter can be left in place until resorption of the pelvic hematoma. Obliteration occurs in 100% of the cases and is treated by open surgery at 3 months. More and more patients are treated by early endoscopic realignment which has diminished by half the incidence of urethral strictures. Impotence and incontinence secondary to trauma or surgery occur in 20% and 10% of the patients respectively. Long term follow-up should be achieved in every patient.     

L'architecture du périnée antérieur masculin

Résumé Etudiée selon des techniques anatomiques et histologiques sur 40 pièces d'adultes et de foetus, l'architecture du périnée antérieur masculin comporte deux types de formations de structure et de topographie différentes. Elle se compose d'un feuillet vertical pré-prostato-vésical, d'une cloison musculo-conjonctive inter-uro-génito-rectale, du noyau central du périnée et d'une lame horizontale de constitution mixte. Ces formations ont un rôle de soutien par leur rigidité ou leur tonicité.     

Desmoid fibromatosis of the posterior mediastinum

Fibromatosis are uncommon connective tissue tumours arising from musculo-aponeurotic tissue and characterised by spindle cell fibroblastic and myofibroblastic proliferation. The exact aetiology is unknown but several factors are considered to be positively correlated with their development and growth (genetic and hormonal factors and trauma). Although they are considered histologically benign they behave aggressively locally and relapse repeatedly after surgical excision. Mediastinal localisation is very rare. We describe a case of de novo fibromatosis of the posterior mediastinum in a 61 year old man with no history of thoracotomy or trauma. Although mediastinal fibromatosis is very uncommon physicians should be aware of this disease in order to ensure appropriate surgical treatment.     

Chirurgie du membre supérieur de l’enfant IMC

Not many spastic patients are candidates for surgery of their upper limb, because of the many other neurologic problems frequently associated. But several surgical procedures are available, aiming at reducing spasticity, correcting muscle contracture, and augmenting paralysed or weak muscles. The main goal is to improve function, but these surgeries may also be indicated to relieve pain, correct orthopedic deformities, facilitate nursing, or improve cosmesis. Surgery should be decided upon only after several sessions of evaluation of the upper limb, with all involved care givers, including clinical examination, video recording, and most of the time botulinum toxin. Family involvement and postoperative care (physiotherapy, splinting) are essential to the success of these interventions. When functional surgery is considered, it should be undertaken early, before the pathologic motor schemes are fixed.     

Tours experience of endovascular treatment in superior vena cava syndrome

Superior vena cava syndrome is a clinical entity including symptoms arising from an obstruction of return flow in the superior vena cava. It can be life threatening. In the context of lung cancer, by far the most prominent etiology (nine of ten cases in our series), the condition is particularly serious, with only 20% survival at one year. Medical treatment may be insufficient, requiring surgical salvage. Palliative procedures are rapidly effective and well tolerated. We perform a first intention transluminal angioplasty under local anesthesia via the right femoral vein. This ultrasound-guided procedure enables insertion of a non-coated nitinol stent. The success rate in our hands has been 90%. Clinical improvement is constant and immediate with long-term efficacy. The early and late post-operative period is uneventful.