Incidental carcinoma of the prostate: significance of staging transurethral resection

We compared the results of staging by a second circumferential transurethral resection and/or transperineal needle biopsy in 42 patients with stage A prostatic adenocarcinoma on initial transurethral resection (defined as tumor of low grade, Gleason sum 2 to 4, and low volume, less than 5 per cent of the specimen or less than 3 foci). Transurethral resection only was done in 16 patients, transperineal needle biopsy only in 2 and both procedures in 24. In the 24 patients who underwent both procedures residual carcinoma was identified by transurethral resection in 6 and confirmed by transperineal needle biopsy in only 1. Thirty-two patients (76 per cent) had no residual carcinoma. Of the 10 patients (24 per cent) with residual carcinoma 5 underwent radical prostatectomy with pelvic lymphadenectomy, 1 had interstitial irradiation with pelvic lymphadenectomy and 1 had pelvic lymphadenectomy only. No lymphatic metastases were detected; persistent carcinoma confined to the prostate was noted in all 5 patients who had undergone radical prostatectomy and 3 of these tumors were upstaged because of higher grade and/or volume. We conclude that residual carcinoma cannot be assessed accurately with transperineal needle biopsy, whereas transurethral resection staging enabled us to define a substantial number of our patients (24 per cent) with persistent disease. Importantly, upstaging by either low volume/high grade or high volume carcinoma was identified in 3 patients at the time of radical prostatectomy. However, the true stage and prognosis of those patients with persistent low volume and low grade prostatic carcinoma remain to be determined.

Ifosfamide: chemotherapy with new promise and new problems for the urologist

Ifosfamide, a chemotherapeutic agent, offers new hope as well as new problems for the uro-oncologist. The "good news" is that this drug is achieving marked benefits in treating resistant testis tumors and may even hold hope for patients with renal cell carcinoma. The "bad news" is that a price must be paid in toxicity--predominantly a severe and restrictive hemorrhagic cystitis. A breakthrough is the finding that oral administration of acetylcysteine (Mucomyst) may, to a large extent, prevent this untoward side effect.

Biopsy-cucumber unit: improved method for preparing bladder biopsy specimens

Specially prepared segments of thinly sliced cucumber, serving as tissue mounts, facilitate the histologic processing of bladder biopsy specimens.

The Life Cycle and Morphology of Tetracerasta Blepta, Gen. Et Sp. Nov., And Stegodexamene Callista, Sp. Nov. (Trematoda: Lepocreadiidae) From the Long-Finned Eel, Anguilla Reinhardtii Steindachner

Two new lepocreadiid digeneans, Tetracerasta blepta, gen. sp. nov., and Stegodexamene callista, sp. nov., are described from the intestine of the long-finned freshwater eel, Anguilla reinhardtii, in the Brisbane River, Queensland, and from the Australian bass, Macquaria novemaculeata, in the Richmond River in New South Wales. Their life cycles have been elucidated and completed in the laboratory, by means of uninfected hosts. Both lepocreadiid species use the prosobranch gastropod, Posticobia brazieri, as their first intermediate host. Cercariae of T. blepta penetrate and encyst in the pharyngeal muscle, external muscle, and viscera of fishes in the genera Gobiomorphus and Hypseleotris, and in several species of tree frog tadpoles. The cercariae of S. callista are often eaten or accidentally inhaled by several small fishes, including Retropinna, Craterocephalus, Pseudomugiland Ambasszs, and encyst in the pharyngeal muscle and viscera. All developmental stages are described and illustrated.

Anatomy and pathology of the male pelvis by magnetic resonance imaging

Magnetic resonance imaging (MRI) of the male pelvis was performed in 25 subjects: five normal volunteers; six patients with carcinoma of the bladder; nine with benign nodular hyperplasia (including five with concomitant bladder carcinoma); nine with prostatic carcinoma; and one with a lymphocele after radical prostatectomy. The display of normal anatomy is enhanced by the ability of the MRI device to provide images in direct transverse, sagittal, and coronal planes. Sessile and pedunculated types of bladder carcinoma are readily shown due to the superior ability of MRI for soft-tissue characterization. Direct sagittal scans are advantageous for evaluation of tumors at the bladder base, and by combining two different planes of images, the extent of the neoplasm is better delineated. In the analysis of the prostate, MRI displays the gland in three dimensions and therefore allows accurate volumetric measurements. The greatest potential of MRI seems to be its ability to detect pathology confined to the gland. However, it is not yet known if a neoplastic nodule can be differentiated from chronic prostatitis. Unlike x-ray CT, metallic clips produce no streaking artifacts, giving MRI a definite advantage in the evaluation of patients after radical surgery. These observations were made on a small number of patients. If the results are confirmed with a larger number of patients, MRI will assume a prominent role in the clinical evaluation of bladder and prostate cancer.

Allergic reaction to protamine: a late complication of elective vasectomy?

Nucleoprotamines are a normal component of human sperm cells. Antibodies against these protamines develop in 22 to 33 per cent of patients undergoing elective vasectomy. These antibodies, in turn, have been shown to cross-react with medicinal protamines, which are extracted commercially from the testes of salmon and certain other fish. This cross-reactivity against protamines raises the possibility that patients who have undergone elective vasectomy may be at increased risk of an allergic reaction developing if they are later exposed to protamine as a medication. Since medicinal protamines currently enjoy widespread clinical use, this information should be borne in mind by those clinician using protamine and by urologists when counselling patients concerning elective vasectomy for sterilization.

Medical information systems: assessing impact in the areas of hypertension, obesity and renal disease

This study described the influence of a computerized medical record summary system in three disease areas (hypertension, obesity and renal disease) observed in the course of a controlled, randomized and prospective study of 479 Northwestern University Clinic patients. Experimental patients, who had available automated record summaries, and control patients, who had available only the manual record, were compared on several medical tests and procedures whose yearly occurrence was considered good medical practice for this patient population, and were compared as well as several measures of outcome of medical care. Evidence suggesting better care and outcome of care among patients with computerized record summaries available is presented.

Triamterene stone: advantage of crystallographic analysis

Microscopic crystallographic analysis of renal calculi provides clinically useful information concerning the pathogenesis of stone disease and is, therefore, superior to conventional chemical analysis of stones. The advantages of crystallography, performed at a centralized, experienced stone-analysis center, are highlighted by the recent discovery of triamterene deposits in kidney stones. Deposits of other medications and their metabolites have also been uncovered. Two case reports are presented, the clinical implications of these and related findings are discussed.

A closer look at serum prostatic acid phosphatase as screening test

Radioimmunoassay techniques for the detection of serum acid phosphatase are reported to provide substantial improvement in test sensitivity and test specificity. Calculation of the positive predictive value for this assay, however, does not support its use as a screening modality. Indiscriminate use of this test may have serious medical, psychological, and economic ramifications.

Perivesical mass and vertical bladder caused by massive prostatic enlargement

Massive prostatic enlargment may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the compouted tomographic findings, is offered. We discuss the differential diagnosis.

Continuous-flow fluoroimmunoassay of serum gentamicin, with automatic sample blank correction

We describe the continuous-flow automation of a quenching fluoroimmunoassay for determination of the antibiotic gentamicin in serum. In the flow system, sample is mixed with fluorescein-labeled gentamicin, followed by antiserum, and after a short incubation the fluorescence is measured. The intrinsic blank signal of each sample is corrected for during its single passage through the system by pumping antiserum discontinuously, so as to divide the final stream into sections corresponding to conventional separate assay and blank mixtures. Analyses time for each sample is 6 min, and 20 samples can be run per hour. Sensitivity, precision, and accuracy are adequate for clinical purposes, and assays of patients' samples correlate satisfactorily with the results of manual quenching and polarization fluoroimmunoassays, and plate diffusion bioassay.

Continuous-flow fluoroimmunoassay of serum gentamicin, with automatic sample blank correction

We describe the continuous-flow automation of a quenching fluoroimmunoassay for determination of the antibiotic gentamicin in serum. In the flow system, sample is mixed with fluorescein-labeled gentamicin, followed by antiserum, and after a short incubation the fluorescence is measured. The intrinsic blank signal of each sample is corrected for during its single passage through the system by pumping antiserum discontinuously, so as to divide the final stream into sections corresponding to conventional separate assay and blank mixtures. Analyses time for each sample is 6 min, and 20 samples can be run per hour. Sensitivity, precision, and accuracy are adequate for clinical purposes, and assays of patients' samples correlate satisfactorily with the results of manual quenching and polarization fluoroimmunoassays, and plate diffusion bioassay.

Estimation of serum gentamicin by quenching fluoroimmunoassay

A new type of non-isotopic immunoassay, applied to the determination of serum gentamicin, is reported. The method is based on partial quenching of fluorescence observed when fluorescein-labelled gentamicin is bound by anti-gentamicin serum. The fluorescence intensity of the labelled gentamicin in an unseparated immunoassay incubation mixture therefore serves to indicate the extent of binding, which is related to the amount of competing unlabelled gentamicin present. Precision and accuracy are shown to be similar to those of the best existing methods for gentamicin, while the new assay is more rapid and technically simpler, and avoids the use of expensive radio-chemicals with their attendant health hazard. Assays of patient samples correlate with established bioassay and polarisation fluoroimmunoassay methods.

Polarisation fluoroimmunoassay of gentamicin

A polarisation fluoroimmunoassay has been developed for the routine determination of gentamicin levels in serum. The method employs fluorescein-labelled gentamicin which is easily, reproducibly and economically prepared and has excellent shelf-life. The assay is fast (minimum incubation time 2 min) and requires 1.25 mul of serum. There is no separation step prior to readout of results. Recovery experiments reveal no serum effects. Intra- and inter-assay coefficients of variation are of the order of 10% or less. Estimations of gentamicin levels in patient serum samples correlate closely with those obtained by bioassay (r = 0.93) and radioimmunoassy (r = 0.97).

Torsion of spermatic cord in neonate

Torsion of the spermatic cord in the neonate should no longer be considered a clinical rarity. Effectual diagnosis is totally dependent on prompt detection of an asymptomatic, irreducible scrotal swelling that fails to transilluminate. Immediate surgical exploration is indicated. Detorsion and careful inspection for signs of circulatory return should be undertaken in every case. Frankly necrotic testes should probably be removed, but conservation of testicular tissue is otherwise strongly recommended, even in the borderline cases. After detorsion testis must be firmly fixed in proper position. Prophylactic contralateral orchiopexy appears to be advisable, unless a congenital hydrocele intervenes. Most importantly, to avert the grim prognosis this condition bears, we must continually alert our colleagues responsible for neonatal care to the possibility of torsion of the spermatic cord in the immediate postpartum examination of every newborn male infant.

Psychopathology and perception of physiques

49 male prisoners, forming 4 diagnostic groups (normals, schizophrenics, passive-aggressives, and sociopaths) defined by actuarial MMPI tables, served as Ss. Diagnostic groups differed significantly in the consistency with which they stereotyped male physiques on the following concepts, child molester, follower, policeman, self, and criminal.

Self-mutilation in female psychopaths

Rampton is a Special Hospital catering mainly for subnormal and psychopathic patients with histories of dangerous and violent behaviour. Earlier work (McKerracher, Street, Segal, 1966) had shown that female patients were significantly more prone than males to mutilate their own bodies and smash hospital property. Such acts are usually regarded in this hospital as hysterical outbursts in which there is often an insensitivity to pain. Gross lacerations are often inflicted without the patient appearing to experience any suffering. Some kind of hysterical anaesthesia may be involved. It is known that this kind of behaviour is found in long-term patients suffering from (a) schizophrenia and (b) severe character disorder (Offer and Barglow, 1960).