Influence of combination chemotherapy with cis-diamminedichloroplatinum on renal function: long-term effects

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined in 8 patients with disseminated testicular carcinoma before, during and 1 year after termination of a combination chemotherapy with cis-diamminedichloroplatinum (CDDP). The decrease in median GFR in comparison with the pretreatment value was 15.5% at the start of the maintenance therapy, 23% at the end of the maintenance therapy and 15.5% 1 year after termination of therapy. The comparable reduction in ERPF at those instants was 15.5, 19 and 23.5%, respectively. At all intervals the changes in GFR were significantly reduced in comparison with pretreatment values. No significant change in both GFR and ERPF was found either during or after discontinuation of maintenance treatment. The fall in ERPF was significant during the total period of treatment as well as during the total time of observation. Thus, no cumulative nephrotoxicity during therapy, nor improvement in renal function thereafter was found. Serum levels of creatinine and beta-2-microglobulin did not express the changes in renal function.

Nephrotoxicity of cis-diamminedichloride platinum (CDDP) during remission-induction and maintenance chemotherapy of testicular carcinoma

We studied renal function in nine patients with disseminated testicular carcinoma before and after remission-induction and maintenance therapy with a drug combination containing cis-platinum. The median glomerular filtration rate (GFR) decreased during remission-induction therapy from 146 to 118 ml/min. No effect of cumulative toxicity on the median GFR was found during maintenance therapy, nor did the median GFR improve. The median effective renal plasma flow (ERPF) decreased during the total period from 705 to 514 ml/min. No significant changes in median filtration fraction (FF) and serum creatinine were observed. It is suggested that intrarenal hemodynamic effects are important in the nephrotoxicity of cis-diamminedichloride platinum (CDDP).

Cloacogenic tumors of the anorectal junction

The cloacogenic zone of the anal canal is a vestigial remnant of the cloacal membrane. This region corresponds to the columnae anales and anal glands. The epithelial lining of the anal glands and of the cloacogenic zone is of the transitional variety. The anal glands are well known to the surgeon because of their role in the pathogenesis of perianal abscesses and fistula in ano. Tumors arising from the cloacogenic zone of the anal canal are rare. In most instants these carcinomas have characteristic clinicopathological features. These lesions are named transitional cloacogenic carcinoma. The therapy of choice is an abdominal-perineal rectum amputation with wide excision of the perineal soft tissue. Inguinal node dissection is indicated if the nodes appear clinically involved. No conclusions have been reached to determine the radiosensitivity of cloacogenic carcinomas. Five cases of cloacogenic carcinoma are reported and the clinicopathological and therapeutic aspects discussed.

Malignant intrathoracic oncocytoma

A case of malignant intrathoracic oncocytoma occurring in a 56-year-old man is reported. Preoperative films of the chest showed a large superior mediastinal tumor. Radical excision through a right-sided thoracotomy was impossible because of the extensive growth. Light and electron microscopic findings revealed a malignant oncocytoma with metastases in lymphoid tissue and tumor emboli in lymph vessels. Postoperative treatment with cyclophosphamide was recommended for one year. After two years there was no radiologic or scintigraphic evidence of metastases. Review of the literature on malignant oncocytoma suggests a relatively benign course after surgical excision. The role of radiotherapy and chemotherapy cannot yet be established.

[The use of juvenile kidneys for transplantation in adults]

In view of the shortage of cadaveric donors a retrospective study has been performed to determine the results of transplantation of paediatric cadaver donor kidneys into adult recipients. Graft- and patient survival and renal function in the 31 cases, analysed in this study, showed no adverse effect of the use of pediatric donor kidneys. No vascular complications were encountered. In only one case ureteric leakage occurred and was treated successfully. It is concluded that paediatric age is no criterion for donor exclusion and that paediatric donors are to be regarded as a valuable source of cadaveric kidneys for transplantation. Also the possibility to perform nephrectomies in anencephalic newborn infants is to be considered.

The use of paediatric cadaver kidneys for transplantation in adult recipients

In view of the shortage of cadaveric donors a retrospective study has been performed to determine the results of transplantation of paediatric cadaver donor kidneys into adult recipients. Graft- and patient survival and renal function in the 31 cases analysed in this study showed no adverse effect of the use of paediatric donor kidneys. No vascular complications were encountered. Ureteric leakage occurred in only one case and it was treated successfully. It is concluded that paediatric age is no criterion for donor exclusion and that paediatric donors are to be regarded as a valuable source of cadaveric kidneys for transplantation.

Effect of selective proximal and truncal vagotomy on canine gallbladder bile composition

In 6 dogs the influence of consecutively a selective proximal vagotomy (SPV) and a truncal vagotomy (TV) on gallbladder bile composition was studied. Following SPV no significant changes in biliary lipids were observed. On the other hand, after TV an increase of deoxycholic acid (D) and a concomitant decrease of cholic acid (C) occurred, resulting in a marked increase of the D/C ratio. Although a positive correlation was found between the D/C ratio and the lithogenic index of bile, the change in bile acid composition after TV was accompanied with only a slight, statistically not significant increase of the lithogenic index. It is concluded that in the dog neither SPV nor TV is a definitely lithogenic procedure.

Transplantation of contaminated organs

In cadaveric organ transplantation there is a risk of transfer of infectious agents from donor to recipient. The consequences can be fatal for immunosuppressed recipients. This is illustrated by a case history in which an infection with the fungus Monosporium apiospermum was transferred from a donor to two cadaveric kidney recipients, of whom one died and the other survived with the loss of the graft. These events led to a review of the literature to determine methods of demonstrating possible contamination of donor organs. Analysis of the case history of potential donors, a history taken from relatives or the family doctor, autopsy and laboratory examinations are considered useful. Victims of drowning, patients with severe burns and patients who have been ventilated for a long time are high risk donors.

A renal function study in 30 patients on long-term lithium therapy

30 patients on long-term lithium therapy have been studied. The results are presented of the urinary concentrating ability after water deprivation and the intranasal administration of vasopressin, of the simultaneous determination of glomerular filtration rate (GFR) and effective renal plasma flow (ERPF), of the minimal urine pH after an oral dose of ammonium chloride, and of the urinary beta-2-microglobulin excretion. Mean urine concentration (+/- SEM) after 22 hr water deprivation (= Uosm) amounted to 854 +/- 22 mOsm/kg H2O, mean GFR was 101 +/- 4 ml/min, mean ERPF 360 +/- 18 ml/min, and mean minimal urine pH 4.95 +/- 0.06. In 8 out of 30 patients there was polyuria. In these 8 patients the values were 778 +/- 51 mOsm/kg H2O, 113 +/- 6 ml/min, 415 +/- 33 ml/min and 4.99 +/- 0.08, respectively. Serum levels of beta-2-microglobulin and lysozyme and the urinary excretion of beta-2-microglobulin were normal in all patients. No correlation was established between Uosm and the serum lithium concentration during the test (0.8 +/- 0.05 mmoles/l) nor between Uosm and the average serum lithium level during treatment (0.79 +/- 0.03). GFR was only correlated with age. It was found that administration of indomethacin during the concentration test increased Uosm in these patients. The results suggest that, given proper dosage and surveillance, long-term treatment with lithium is not likely to cause disturbances in renal function.

Occlusive phlebitis, a diagnostic feature in Riedel's thyroiditis

Five cases of Riedel's invasive fibrous thyroiditis are presented. Clinically and histopathologically all cases fulfilled the criteria for this lesion. In both small and large veins there were inflammatory changes and obliteration of the lumen, followed by sclerosis. These changes were found in each operative specimen, and seemed to be a diagnostic feature of invasive fibrous thyroiditis. We consider this change to be an occlusive phlebitis, and have noted that it occurs in association with multifocal fibrosclerosis. Three stages can be recognised: infiltrative, occlusive and sclerotic. In other thyroid lesions such as Hashimoto's thyroiditis, granulomatous thyroiditis of the Quervain type and adenomatous goitre these peculiar changes in the veins were not found.

Syndrome of Shwachman and leukaemia

The syndrome of Shwachman is characterized by pancreatic insufficiency and bone marrow dysfunction, usually manifesting itself as neutropenia. The pancreas shows replacement of the exocrine glands by adipose tissue; sweat electrolytes are normal. A 23-year-old male who was known to suffer from neutropenia and pancreatic dysfunction from early childhood, presented with fever, acquired Pelger-Huet anomaly (of the polymorphonuclear granulocytes) and sideroblastic anaemia, a combination of symptoms suggestive of preleukaemia. A few months later he died of acute myeloblastic leukaemia and autopsy showed a dystrophic pancreas. Considering this case history it seems possible that the haematological anomalies of Shwachman's syndrome are signs of preleukaemia. Careful follow-up of patients suffering from Shwachman's syndrome seems warranted.

Idiopathic retroperitoneal fibrosis in multifocal fibrosclerosis

A case of rare combination of retroperitoneal fibrosis and Riedel's thyroiditis is presented. The term multifocal fibrosclerosis is used in the literature to denote such combination and others which include idiopathic retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, invasive (Riedel's) thyroiditis and pseudotumor of the orbit.

Thyroid carcinoma after 131I treatment for hyperthyroidism. Report of a case

A case of anaplastic thyroid carcinoma is described, occurring in a 71-year-old woman, 8-1/2 years after treatment with 8 mCi 131I for hyperthyroidism.