[Urinary lithiasis in children].
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Biomedical subjects
Publications and source records attributed to L Wemeau.
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Renal angiomyolipomas are benign mesenchymal tumours. Whether isolated or associated with phacomatosis, they are histologically identical, but it is often difficult to distinguish an isolated angiomyolipoma from renal cancer. When it is combined with phacomatosis, it is frequently bilateral and can provoke retroperitoneal haemorrhages. These peculiarities qualify the therapeutical management which would a priori be conservative in the case of a benign tumour.
Remembering that the diagnosis of stress urinary incontinence is essentially clinical, the authors describe the fundamental stages of their technique, i.e. the musculo-aponeurotic suspension of the bladder neck (Goebell-Stoeckel technique). This operation has enabled them to have good results in 88% of their cases. The long-term study of these results shows slight deterioration of the success rate which becomes stable after 2 years.
155 children presenting with lithiasis have been studied. The study confirms other recent analyses: (1) Urinary lithiasis in the child is far more frequent than was previously thought. It is not always easy to diagnose because of the limited opacity of the calculi. (2) Its secondary nature is shown in 25% of the cases. (3) Its cause is still debated in spite of the evident part played by Proteus infection. (4) The prognosis is generally favourable.
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Secondary tumours of the kidney are relatively common. Found at autopsy in approximately 4 per cent of patients dying of malignant disease, they are clinically latent in most instances. Thus in a total series of 295 malignant tumours of the kidney, only 8 were metastases. The primary tumour is most often a bronchial carcinoma, this being confirmed in our series (5 cases). This is followed, in order of decreasing frequency, the breast, stomach, pancreas and stomach. Two of the 8 cases were rarities: a renal metastasis from a meningoblastoma and a metastasis from one tumour to another, a carcinoma of the ovary metastasising to a hypernephroma. The pathogenesis of these secondary tumours leads to the consideration of 2 modes of spread: haematogenous and lymphatic. They present no special clinical features. Intravenous pyelogram reveals the appearances of a malignant tumour mass. Angiography is more informative, the results reflecting the histological nature of the primary tumour. The latter being most frequently a carcinoma, the arteriographic image is one of hypovascularisation, thus differing from a hypernephroma with its rich vascularisation and resembling an infiltrating pelvi-calyceal carcinoma. Histopathological examination is not always conclusive itself. Nephrectomy is effectively only justified if the primary tumour has been or can be successfully treated in the absence of other metastases.
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