Bilateral ureteral atresia

Congenital, bilateral, distal ureteral atresia with severe renal dysplasia in a preterm infant is presented. This rare anomaly is caused by a variable degree of failure of the ureteral bud development. Prognosis is usually dependent on the severity of the obstruction.

[Transthoracic approach for removing adrenal masses]

Early results with the transthoracic approach for removing adrenal tumors were evaluated. Between May 1994 and December 1995, 8 women and 5 men (aged 18-74) with adrenal masses underwent transthoracic adrenalectomy. All were excised successfully with short operation times (mean: 86 min), minimal blood loss (151 ml), limited use of parenteral analgesics (1.3 days), early ambulation (1.7 days post operation) and a short period of parenteral nutrition (1.7 days), resulting in reduced hospital stay (mean 6.7 days). With the transthoracic approach procedures are quick and safe even for large, malignant, and hormone-producing tumors. Recovery is easy with brief hospitalization. It provides excellent exposure of the adrenals, enables good control of bleeding vessels and is therefore our preferred method for removing adrenal masses.

Percutaneous ablation of malignant liver tumor in rabbits using low radio frequency energy

Radio frequency (RF) current has been used successfully to ablate normal human tissue. To further investigate the clinical application of this modality in tumors we studied the potential of using RF percutaneously to destroy experimental liver tumors. Thirty five outbred albino rabbits underwent liver VX2 tumor direct-implantation during open surgery. After 21 days ultrasonography was performed revealing tumor presence and size. A shielded RF needle was designed so that it could be inserted percutaneously through an introducing needle, and an electrical insulation shield covering the RF needle could be retracted to control the length of the exposed RF needle inside the tissue. Twenty two days after tumor implantation RF was applied via the aforementioned needle using a ZoMed International RF generator. In one group of rabbits the procedure was performed under direct vision during open surgery and on the other group treatment was applied percutaneously, guiding the needle by tumor palpation. Rabbits were killed 3 days later and pathology revealed 4 to 25 mm intratumoral RF induced lesions. A direct relation was found between lesion size, power and duration of RF application (At 7.5 W, r = 0.48, p = 0.032). Based on our preliminary results we may conclude that RF may have clinical application in the near future for percutaneous local tumor control in parenchymal organs.

The use of an ultrasonic assisted lipectomy device for the treatment of obstructive pelvic lipomatosis

Pelvic lipomatosis is a rare disease of unknown etiology characterized by overgrowth of pelvic fat. We describe a 60-year-old man with pelvic and retroperitoneal lipomatosis causing severe urinary obstruction with massive hydroureteronephrosis. The diagnostic procedure and the management of the patient is described, emphasizing the value of the Ultrasonic Assisted Lipectomy device in performing ureterolysis.

A comparison between histological grade and nuclear morphometry for predicting the clinical outcome of localized renal cell carcinoma

OBJECTIVES

To determine the interrelationship of histological grade and nuclear morphometry and to compare their prognostic significance in patients with localized renal cell carcinoma (RCC).

PATIENTS AND METHODS

A retrospective prognostic study of 39 patients with localized (pT1, pT2) RCC was performed. Conventional histological grade and nuclear morphometry were assessed independently and the correlation between these grading systems and their impact on the patients' outcome were evaluated.

RESULTS

Histological grade and the nuclear morphometric variables were significantly correlated: the strongest association was that between grade and the nuclear regularity factor. The best predictor of disease-free interval and survival (by univariate analysis) was the combination of nuclear area and nuclear elongation factor, followed by conventional tumour grade, nuclear elongation factor, nuclear regularity factor and nuclear area. However, a multivariate analysis showed that the only independent prognosticator for survival was the combination of nuclear area and nuclear elongation factor.

CONCLUSIONS

This study indicates that nuclear morphometry is prognostically superior to histological grade in patients with localized RCC.

Facilitation of glutamate receptors reverses an age-associated memory impairment in rats

The accuracy of memory for recent events is reported to decay between young adulthood and middle age in humans (Crook et al., 1990; Crook and West, 1990; Thomas et al., 1977) due to impairments in acquisition and/or retention (Craik, 1977; Huppert and Kopelman, 1989). Effects of this kind are also found in comparisons of middle-aged (12-18 months) vs. young adult (3 months) rats in tests requiring retention of recently sampled spatial cues (Kadar et al., 1990a; Kadar et al., 1990b; Goudsmit et al., 1990; Weiss and Thompson, 1991). The causes of such changes in memory processing are unknown but might be expected to involve age-related losses in forebrain glutamate receptors (Bahr et al., 1992; Magnusson and Cotman, 1993; Wenk et al., 1991); these receptors mediate fast excitatory transmission in many brain regions and play an essential role in the production of long-term potentiation (LTP), a form of synaptic plasticity that has been implicated in memory encoding (Landfield and Lynch, 1977; Moore et al., 1993). In the present communication we report results indicating that a drug that enhances AMPA-type glutamate receptors acts centrally to selectively increase hippocampal spatial cell firing and improves both acquisition performance and memory retention in middle-aged rats to levels equivalent to those found in young adult animals.

Anuria and acute renal failure caused by multiple bladder calculi

A rare case of multiple bladder stones (more than 300) is described. Acute renal failure and anuria complicated by urosepsis were the presenting symptoms.

Sublingual buprenorphine compared to morphine delivered by a patient-controlled analgesia system as postoperative analgesia after prostatectomy

After open prostatectomy, 52 patients were randomly allocated to two treatment groups. Group A (26 patients) received buprenorphine sublingually, and in group B (26 patients) the analgesia was induced using a patient-controlled analgesia system with morphine. The total dose of morphine given during the first 24 h was 72 +/- 8 mg compared to 1.6 +/- 0.45 mg of buprenorphine. The total dose of buprenorphine on days 2 and 3 was significantly lower than the total dose of morphine (p < 0.01). There were no significant differences in visual pain scores, side effects, mean arterial blood pressure, pulse rate and respiration rate between the two groups. Sublingual application of buprenorphine offers an effective and easy alternative to the parenteral route of morphine for the management of postoperative pain.

Transthoracal approach for the removal of adrenal tumors. Early experience with 10 cases

OBJECTIVES

To evaluate the early results of a transthoracal approach for the removal of various adrenal tumors.

METHODS

Between May 1994 and March 1995, 10 patients with adrenal masses underwent transthoracal adrenalectomy. Operation time, blood loss, the use of parenteral analgesia, duration of thoracal drainage, time to oral intake, ambulation and hospitalization period were assessed.

RESULTS

All tumors were excised successfully, with a short operation time (mean 91.5 min), minimal blood loss (mean 35 ml), limited use of parenteral analgesics (mean 1.4 days), early ambulation (mean 1.9 days to ambulation) and shorter period of parenteral nutrition (mean 2 days) leading to a reduced hospital stay (mean 6.7 days).

CONCLUSIONS

The transthoracal approach provided excellent exposure and is a quick and safe procedure even for large, malignant and hormone-producing tumors. At present this is our preferred method for the removal of adrenal masses.

Three-dimensional imaging using spiral computerized tomography prior to tumor enucleation in a patient with a solitary kidney

The authors present a case of renal cell carcinoma in a man with a solitary kidney. Three-dimensional computerized tomography instead a selective renal angiography was used preoperatively as a noninvasive technique for visualization of the renal tumor and renal vascularization.

The role of nuclear morphometry for predicting disease outcome in patients with localized renal cell carcinoma

BACKGROUND

More than one-third of patients with localized renal cell carcinoma (RCC) will have disease progression after nephrectomy. Present histopathologic variables cannot accurately predict the outcome of individual patients.

METHODS

Nuclear morphometry was performed by an image analyzer on histologic sections from 39 specimens of pathologic T1 and T2 classification RCC. All patients underwent radical nephrectomy and were followed for a mean of 7.6 years. A univariate analysis and then a multivariate stepwise regression method were used to correlate results with patients' outcome.

RESULTS

The best predictors of disease free interval were mean nuclear elongation factor (MNEF) (P = 0.023), mean nuclear regularity factor (MNRF) (P = 0.034), and mean nuclear area (MNA) (N = 0.038). Univariate analysis identified a significant correlation between patient survival and MNEF (P = 0.009), MNRF (P = 0.020) and MNA (P = 0.023). Combination of MNEF and MNA was even more strongly associated with survival (P = 0.0013). Multivariate analysis revealed that MNA (P = 0.044) and MNEF (P = 0.045) correlated independently with survival.

CONCLUSION

These results suggest that nuclear morphometry provides objective independent prognostic information for patients with localized RCC.

Acute orchitis in recurrent polyserositis

The authors report an unusual case of bilateral short term acute orchitis in a patient with recurrent polyserositis (familial Mediterranean fever).

Successful treatment of postretroperitoneal lymph node dissection in massive chylous ascites

A rare complication of retroperitoneal surgery is damage to lymphatic vessels, leak of chyle and the development of chylous ascites. This complication can be life threatening and has a relatively high mortality rate. We describe a 38-year-old patient with a massive chylous ascites after extensive retroperitoneal lymph node dissection of metastatic nonseminomatous germ cell testicular tumor. The patient was treated surgically and with fat-free diet, medium chain triglycerides and diuretics resulting in complete resolution of the ascites.

Glutamine metabolism and utilization: relevance to major problems in health care

Glutamine plays an important role in normal and pathophysiological states. In this review we describe the biochemical synthesis and degradation pathways of glutamine, as well as its utilization by the immune system and in rapidly dividing cells. Also discussed are glutamine behaviour in catabolic states and the therapeutic implications of this amino acid in total parenteral nutrition, digestive diseases and cancer.

Quantitative SPECT of technetium-99m-DMSA uptake in the kidneys of normal children and in kidneys with vesicoureteral reflux: detection of unilateral kidney disease

Quantitative SPECT was used to evaluate renal functional volume (cc), percent of injected dose/cc (%ID/cc) and renal uptake (%) in 11 children with unilateral vesicoureteral reflux grade 3 or greater, and in 19 normal control children without reflux.

METHODS

Studies were performed 4-6 hr after intravenous injection of 0.750-2 mCi of 99mTc-DMSA.

RESULTS

Control kidneys (n = 38) had a volume of 99.7 +/- 29.5 cc. The %ID/cc was 0.27 +/- 0.08, and the uptake in one kidney was 24.8% +/- 3.9%. Global renal uptake (right plus left) was 49.6% +/- 7.3%. Functional volume of the control kidneys showed an increase with age, and the %ID/cc showed a steeper decrease with age, resulting in a trend of the kidney uptake to decrease with age. Kidneys with reflux had a decreased kidney uptake of 15.7% +/- 29.5%, compared to age- and sex-matched controls (t = 4.7, p < 0.001). The contralateral kidneys without reflux had a significantly increased total uptake of 33.4% +/- 6.8% as compared to controls (t = 3.44, p < 0.01). Global uptake by the kidneys was 49.2% +/- 8.6% and was not statistically different from controls (t = 1.0, ns).

CONCLUSION

Our results suggest that SPECT quantitation of 99mTc-DMSA uptake in each kidney separately could be used as a noninvasive method to assess impairment and compensation of the function of the individual kidney in children with vesicoureteral reflux.

Results of conservative management of clinically localized prostate cancer

BACKGROUND

The selection of treatment for patients with localized prostate cancer requires reliable information about the outcome of conservative management. Previous studies of this question are generally considered unreliable because they were uncontrolled and nonrandomized.

METHODS

We performed a pooled analysis of 828 case records from six nonrandomized studies, published since 1985, of men treated conservatively (with observation and delayed hormone therapy but no radical surgery or irradiation) for clinically localized prostate cancer. A Cox regression analysis was performed to determine which factors influenced survival among patients who did not die of causes other than prostate cancer (disease-specific survival). Kaplan-Meier curves for overall and metastasis-free survival among such patients were compared with use of the log-rank method and the Mantel-Haenszel test.

RESULTS

Factors that had a significant effect on disease-specific survival were grade 3 tumors (risk ratio, 10.04), residence in Israel (risk ratio, 2.48) or New York (risk ratio, 0.37), and age under 61 years (risk ratio, 0.32). Ten years after diagnosis, disease-specific survival (with data on men who died from causes other than prostate cancer censored) was 87 percent for men with grade 1 or 2 tumors and 34 percent for those with grade 3 tumors; metastasis-free survival among men who had not died of other causes was 81 percent for grade 1, 58 percent for grade 2, and 26 percent for grade 3 disease. These findings were not affected by the inclusion of men who had early-stage cancer, were older, had worse-than-average health, or underwent delayed radiation therapy or radical prostatectomy.

CONCLUSIONS

The strategy of initial conservative management and delayed hormone therapy is a reasonable choice for some men with grade 1 or 2 clinically localized prostate cancer, particularly for those who have an average life expectancy of 10 years or less. New treatment strategies are needed for men with grade 3 prostate cancer.

The malignant potential of postchemotherapy residual mature teratoma for disseminated nonseminomatous testicular tumors

Flow cytometric nuclear DNA ploidy analysis was used to study 7 paraffin-embedded tissue blocks from 3 patients with postchemotherapy residual mature teratomas. All specimens contained abnormal DNA and were classified as DNA aneuploid. These findings indicate that despite the benign appearance of postchemotherapy mature teratomas, these lesions are susceptible to resume malignant behavior. Therefore, complete surgical removal is recommended.

Second primary cancer in irradiated stage I testicular seminoma

The incidence of second primary cancer (SPC) was determined in 64 irradiated stage I testicular seminoma patients, treated and followed at the Northern Israel Oncology Center from 1968 to 1988. Seven (11%) patients developed a total of eight second cancers. The cumulative risk for developing second primary cancer at ten, 15 and 20 years following the diagnosis of seminoma was 2.5%, 5.1% and 8.9%, respectively. Two patients developed SPC within the radiation field (urinary bladder, sigmoid colon) and four patients outside the radiation field (bronchogenic cancer, thymoma, malignant melanoma, thyroid cancer). In two patients, who developed lung cancer and testicular seminoma, respectively, scatter dose from the main radiation field could not be excluded as one of the factors contributing to the SPC. Three patients died as a direct result of their SPC. It is concluded that there is a low, but significant risk of solid SPC among patients apparently cured of early stage seminoma. It will be important in future surveillance studies of stage I seminoma to assess the risk of SPC in the non-irradiated patients.

Metastatic renal cell carcinoma to the bladder

We report a case of metastatic renal cell carcinoma to the bladder. Our patient presented gross hematuria 6 months after treatment of the primary lesion. The possible routes and treatment regimens of metastasis of this site of lesion are discussed and a review of the literature is presented.

Squamous cell carcinoma of the prostate

A case of the rare squamous carcinoma of the prostate is herein presented. Squamous cancer accounts for 0.5-1% of prostatic malignancies. The patient died of systemic metastases 5 months after diagnosis. Review of the literature suggests that such a cancer is highly aggressive and responds poorly to any mode of therapy, perhaps because of a different cell of origin.