Actual all-arthroscopic techniques for the treatment of osteochondral defects of the ankle joint

The treatment of osteochondral lesions of the talus (OCL) is demanding. Matrix associated techniques are used more and more as a standard, suggestion a more reliable healing. Nevertheless, approaching especially central and medial OCL is still demanding. Medial malleolus osteotomies routineously used, can be a source of morbidity and complications. Improving arthroscopic techniques allow an all-arthroscopic treatment of these defects.     

Surgical aspects of kidney transplantation in children (study of 148 cases)

OBJECTIVE: Kidney transplantation is the best treatment for end-stage renal disease. This procedure is by now routinely used and permits children survival and rehabilitation. We describe the surgical complications of kidney graft in our paediatric experience. MATERIALS AND METHODS: From April 1987 to August 2000, 175 kidney transplantation were proceeded in the department of urology and transplantation in Edouard Herriot Hospital (Lyon). Twenty-nine kidneys (17%) were from living related donors and 146 (83%) were from cadaveric donors. We evaluated 148 kidney transplantation (132 patients) in 79 male and 53 female children. Mean age was ten years (range: seven months to 18 years). Twelve allografts were from living related donors and 136 cadaveric donors. RESULTS: Twelve patients died of various medical complications. One patient was lost of sight. Surgical complications were postoperative bleeding, lymphocele, urologic and digestive troubles. The rest of our patients had uneventful evolution. CONCLUSION: A general commitment is the only way to promote organ donation and enable patients with terminal renal failure to have access to renal transplantation.     

Plasma levels, half-life values, and correlation with physiologic assays for growth and immunity

To assess the gonadal effects of chlorambucil given to prepubertal and pubertal boys, testicular function of 21 adolescents or young men, treated with chlorambucil for nephrotic syndrome before or during puberty, have been evaluated. Evaluations have been based on penis and testicular size, serum FSH, LH and testosterone values, and sperm count. Nine patients have testicular hypotrophy, 13 have significantly elevated FSH, 17 have azoospermia, two have severe oligospermia, and repetitive sperm counts show no improvement. A quiescent state of the epithelium of the seminiferous tubules does not protect against chlorambucil toxicity, which seems to be related to the cumulative dose. Chlorambucil should be used with caution, even in children.     

Retroperitoneal fibrosis

The rare occurrence of retroperitoneal fibrosis contrasts with the multitude of publications. Its clinical expression also contrasts with the severity of its repercussion on renal function. Now, diagnostic and therapeutic are more standardized to improve chances of preserving renal function. However, no surgical or medical therapy has been tested in a randomized, controlled trial. This article proposes an update of knowledge on this subject.     

Emphysematous pyelonephritis: a case report

Diabetic patients with urinary tract infections had a certain risk of developping emphysematous pyelonephritis with gas producting bacteria. This disease was accompagned with high mortalité. We will report one case who was treated successfully by high dose antibiotic regim and emergency nephrectomy.     

Cystic diseases of the kidney

Cystic diseases of the kidney constitute a heterogeneous family. Most renal cysts are benign and asymptomatic, and don't have any impact on renal function. These "simple" cysts are usually managed conservatively. However, some renal cysts may be symptomatic or may have atypical radiological presentation, leading to suspicion of malignant tumour; puncture or surgical investigation may be indicated in such cases. The other cystic renal diseases include specific entities, either genetic or acquired during development. Some malformative syndromes are often associated, and renal function may be impaired. In such cases, nephrectomy is required.     

Measurement of renal function in clinical practice: principles and limitations

Methods for measurement of glomerular filtration rate (GFR) (clearance in plasma, urine or both of an « exogenous » tracer, usually radio labeled) often are considered impractical from a clinical standpoint. Alternate methods proposed to estimate the GFR are based on plasma levels of « endogenous » tracers (creatinine, cystatin C). These methods are so imprecise that they provide little if any true reassurance with regards to warnings and recommended GFR values for the use of iodinated and gadolinium based contrast agents.