Stone induced ureteral rupture: The worst-case scenario. A case report

Forniceal rupture secondary to acute ureteral obstruction is relatively common. However, spontaneous ureteral rupture is less frequently encountered. Most reported cases were stone related, localized at the ureteropelvic junction and managed in a minimally invasive manner. We present a case of stone induced ureteral rupture below the UPJ, with bacterial and fungal superinfections, that failed conservative management and lead eventually to nephrectomy. No such scenario has ever been reported in the literature. As rupture of the ureter can cause serious complications, including urinoma, sepsis and sometimes kidney loss, prompt recognition, treatment and follow-up of the condition is therefore necessary.

Immunodynamics of explanted human tumors for immuno-oncology

Decision making in immuno‐oncology is pivotal to adapt therapy to the tumor microenvironment (TME) of the patient among the numerous options of monoclonal antibodies or small molecules. Predicting the best combinatorial regimen remains an unmet medical need. Here, we report a multiplex functional and dynamic immuno‐assay based on the capacity of the TME to respond to ex vivo stimulation with twelve immunomodulators including immune checkpoint inhibitors (ICI) in 43 human primary tumors. This "in sitro" (in situ/in vitro) assay has the potential to predict unresponsiveness to anti‐PD‐1 mAbs, and to detect the most appropriate and personalized combinatorial regimen. Prospective clinical trials are awaited to validate this in sitro assay.

[The Munchausen syndrome: a diagnosis not to be forgotten in urology]

INTRODUCTION

Among the manifestations of Münchausen's syndrome, "neurological" forms may exist.

OBSERVATION

We present the case of a patient presenting with urinary retention following treatment for urinary incontinence. The patient had injected himself with infected urine collected from his catheter, in order to create septicemia.

COMMENTS

Nephritic colitis, false gall stones, addition of fecal matter or of food and saliva in the urine or the bladder, neurogenic bladder and urinary infections have all been reported as possible manifestations of Münchausen's syndrome. Diagnosis of this syndrome is often delayed and laborious, after repeated hospitalisations, examinations and often aggressive treatment. Its therapeutic management is difficult. Patients, despite proof, deny their deceit and refuse psychiatric care.

Acute selenium poisoning

Reports of acute human selenium toxicity are rare. We report 2 new cases. One patient ingested a mouthful of selenic acid (30 g/L); he only suffered mild gastrointestinal disturbances. Serial measurements of plasma selenium concentrations were performed. The first plasma level was obtained 3 h after ingestion and was the highest (931 micrograms/L); plasma concentrations subsequently decreased with a half-life of 17.5 h. The second patient ingested 1.7 g of sodium selenite. He suffered severe gastroenteritis, had transient electrocardiographic changes and developed a slight elevation of serum bilirubin. The first serum concentration measurement was performed 3 h after ingestion; the selenium level was 2.716 micrograms/L. These data are compared to those from other published cases. The prognostic significance of the blood selenium concentration is discussed.

[Infections caused by Mycobacterium africanum]

Mycobacterium africanum is a bacterial species that was singled out in 1969. Its biochemical and cultural characteristics are intermediary between those of Mycobacterium tuberculosis and Mycobacterium bovis. This bacteria is responsible for tuberculosis in both western and central Africa. We can distinguish between four different types dependent upon the geographical origins of the patients. The extent of this case, with multiple cutaneous and visceral lesions, could not be explained by a past or associated disease or by an immunological defect, be it congenital or acquired.