Deux cas de reins en fer à cheval en position ectopique

Résumé Etude de deux cas de reins en fer à cheval dans lesquels la portion gauche du parenchyme est en situation para-normale alors que la portion droite est en situation basse, au devant des gros vaisseaux, l'isthme étant dans chaque cas décalé au flanc latéral gauche de l'aorte.Ces dissections permettent de préciser l'origine et la distribution des vaisseaux artériels et veineux. Bien qu'en situation basse, la portion droite du parenchyme rénal reçoit dans les deux cas une artère naissant de l'aorte au niveau d'une artère rénale normale et le retour veineux se fait par la veine cave inférieure dans les mêmes conditions. Une partie de la vascularisation dépend toutefois de la portion terminale de l'aorte, de la bifurcation aortique et des axes iliaques primitifs.Dans un cas existait un anévrisme de l'aorte.     

Surgical management of giant lumbar disc herniation: Analysis of 154 patients over a decade

BackgroundWe describe a decade of our experience in the surgical management of patients with giant lumbar intervertebral disc herniation (GILID).MethodsThis is a case series of patients operated for a GILID between 2000 and 2009. Among 1334 patients eligible for the present study: 154 patients presented with GILID (study group) and 1180 patients without GILID (control group). Clinical symptoms and preoperative imaging results were obtained from medical records. Complications and long-term results were assessed.ResultsThis retrospective study documents the characteristic features between patients with and without GILID. The difference in the incidence of female patients was statistically significant between the study group and the control group as was the mean duration of symptoms, hyperalgic radicular pain, bilaterality of symptoms, preoperative motor deficit, central location of lumbar disc herniation (LDH), contained herniation and recurrence of LDH.ConclusionsGILIDs are a distinct entity: they are distinctly uncommon compared with smaller herniations, patients were statistically more likely to be hyperalgic with bilateral radicular pain and often associated with neurological deficits. The majority of patients do not display a cauda equina syndrome (CES). Low lumbar disc sites are mostly affected and disc fragments are more likely to be central-uncontained. The recurrence rate is lower for GILIDs.     

Pathologic horseshoe kidney. Report of 13 cases

The authors report a series of 13 horseshoe kidneys observed over a 22-year period. All patients are men with a mean age of 39 years (20-65 years). The clinical features were dominated by abdomino-lumbar pain (nine cases). The horseshoe kidney was associated with renal stones in nine cases, uretero-pelvic junction syndrome in five cases and pyonephrosis in one case. The specific anatomic and surgical features of this rare malformation are emphasized and the therapeutic features of each uropathy associated with horseshoe kidney are discussed.     

Kidney cancer in horseshoe kidney. A case report of an unexpected diagnosis

The authors report a case of renal cell carcinoma in a horseshoe kidney and discuss diagnostic and therapeutical aspects arising from this combination. Renal carcinoid tumors and nephroblastoma seems to be more frequent in this malformation. Diagnosis of horseshoe kidney may be difficult and angiography examination is very useful to confirm renal anomaly, tumor situation, and to plan the surgical approach because vascularization vary case to case. Heminephrectomy adapted to neoplasic localisation remains the essential treatment.