Systemic herpes simplex virus type 2 infection. Proctitis, urinary retention, arthralgias, and meningitis in the absence of primary mucocutaneous lesions

A 24-year-old heterosexual man had severe proctalgia associated with nonspecific proctitis. Within a few days, perineal and lower extremity paresthesias, intermittent urinary retention, inguinal lymphadenopathy, lower extremity arthralgias, and aseptic meningitis developed. Serologic studies demonstrated a fourfold rise in convalescent antibody titer to herpes simplex virus (HSV) consistent with an initial type 2 infection. Six months later, HSV type 2 was isolated from perianal vesicles, which we believe was the first cutaneous manifestation of a recurrence. This unusual syndrome, presumably the result of HSV ganglionitis, could be confused with other disorders that include multiple sclerosis, lumbar disk disease with radiculopathy, rheumatologic disease, and psychogenic illness. In the absence of typical herpetic mucocutaneous vesicles, serologic studies may be useful in the diagnosis of a systemic herpes simplex infection.

Wilms tumor, misdiagnosed preoperatively: a review of 19 National Wilms Tumor Study I cases

This study establishes the difficulty in making specific diagnoses in children with retroperitoneal tumors when only excretory urograms are used in diagnosis. Complementary use of excretory urography and ultrasonography should make the number of preoperative errors less by separating cases of Wilms tumor from those with cystic disease. This investigation underscores the hazards inherent in the use of preoperative irradiation and chemotherapy, since some children with benign disease are likely to receive inappropriate therapy.

Isolated torsion of penis. Report of 6 cases

Torsion of the penis as an isolated anomaly has rarely been reported. Six such cases seen in a pediatric urologic practice within a two and one-half-year span suggest that it is not as rare as has been hitherto suggested. The embryologic abnormality appears to be an isolated skin and dartos defect, since the torsion is completely remedied by simply freeing the penile shaft of its investing tissue. The ease of achieving a normal appearance would appear to justify its surgical correction.