Does this case hold the answer to one of the worse types of pain in medicine--that of loin pain haematuria syndrome (LPHS)

A patient with loin pain haematuria syndrome suffering chronic throbbing pulsing pain overlaid with prolonged periods of incapacitating colic and overnight vomiting was presented 10 months following diagnosis. Ultrasound was normal. No renal or ureteral stones, or filling defects were seen on CT. At cytoscopy, bladder and urethra were normal, and bloody urine effluxed from the left ureteric orifice. The ureters were normal at diagnosis, and developed new abutting non‐penetrating calcifications by 8 months. Pain episodes of complete incapacitating intensity of 2–4 h duration were reduced to 10 min with 5 mg crushed tadalafil administered at onset. If tadalafil was delayed to after onset, the original course of agony resulted. Daily tadalafil reduced loin pain intensity, but not the exacerbations. Tadalafil efficacy may indicate that the pain exacerbations are due to spasm of ureter smooth muscle. 5 mg tadalafil taken at onset alleviated severe loin pain exacerbations in this case of loin pain haematuria syndrome.

Equality versus Fraternity? Rethinking France and its Minorities

The relationship between France and its minorities is complex. Recent events including the 2015 terrorist attacks, the prohibition on wearing religious symbols in public, or the 2005 riots, have been perceived as symbols of great tension in French society when its comes to its minorities.2 Indeed the ten-year anniversary of the riots prompted reporting that nothing had changed in the intervening period in the structures of inequality that caused them,3 while in January 2015, the French Prime Minister Manuel Valls declared that the country was facing a “territorial, ethnic and social apartheid”.4 This statement from the Prime Minister seems to be at odds with the overall policy of rejecting any targeted policies or laws to protect minorities in France. As a tradition France is against minority rights. French authorities have consistently rejected the use of the term ‘minorities’, and have banned any form of special measures for national, racial, ethnic, religious or linguistic groups.5