Abscess of corpus cavernosum

A rare case of abscess of the corpus cavernosum is described. Culture of the abscess yielded beta-hemolytic streptococcus. Ultrasound scan and cavernosography confirmed the physical examination findings of involvement of the corpus cavernosum. The patient was treated successfully by percutaneous ultrasound-guided aspiration drainage and systemic antibiotic therapy.

[Spermatocytic seminoma of the testis]

During 1968-1988, 6 patients with Stage I spermatocytic seminoma were registered at this oncology center. They represent 7% of a total of 83 patients referred for testicular seminoma (mean age 41 years, range 30-75). All 6 underwent high inguinal orchiectomy and 5 received postoperative radiotherapy. 1 refused any postoperative treatment. In a mean follow-up of 64 months (range 25-204), 4 patients were alive with no evidence of disease, 1 had died of ischemic heart disease without evidence of recurrence of the seminoma, and 1 was lost to follow-up after no evidence of disease was found 90 months after radiotherapy. In the light of our experience and reports in the literature, spermatocytic seminoma has a very good prognosis, although metastatic potential cannot be ruled out. Decision as to treatment should be based mainly on the stage of the disease.

Effect of extracorporeal piezoelectric lithotripsy shock waves on renal function measured by Tc-99m-DMSA using SPECT

Extracorporeal shock-wave lithotripsy has altered the therapeutic approach to urinary stone disease. Recently, a method was developed in which shock-wave generation is obtained piezoelectrically. To evaluate the effect of extracorporeal piezoelectric lithotripsy (EPL) on renal function, 20 patients were studied prior to and after EPL of renal calculi. Renal cortical function was evaluated by using a previously described and validated quantitative single photon emission computerized tomography (SPECT) method to measure individual absolute uptake of technetium-99m dimercaptosuccinic acid (Tc-99m-DMSA). Twenty kidneys were treated, and the 19 contralateral kidneys were without stone disease (1 patient had a single kidney). The absolute kidney uptake of Tc-DMSA in the normal kidneys was 21.4% +/- 6.2% before and 22.2% +/- 6.4% after EPL. For the treated kidneys the absolute update was 16.8% +/- 5.3% and 16.8% +/- 4.7% before and after, respectively. There was no statistical significant difference between pre- and post-treatment values. The absolute kidney uptake was significantly lower (p less than 0.01) in the treated than in the normal kidneys. This study indicates that the EPL procedure did not cause any damage to cortical function detectable by the DMSA uptake.

[Intracavernous pharmacotherapy for treatment and evaluation of impotence]

Impotence affects about 10% of all men. During the past decade it has been treated with self-injection of vasoactive drugs into the erectile tissue. In 1982 Virag reported experience with intracavernous injection of papaverine. Since then other vasoactive drugs, such as prostaglandin E1 (PGE1), have been used successfully, and self-injection has been advised. Between 1987-1989 we evaluated 550 patients with erectile dysfunction and 95 aged 21-79, mean 53.7, were found suitable for this treatment, of whom 80 were entered into an autoinjection protocol, of 74 were treated with a mixture of papaverine and regitine and 6 with PGE1. The volume of the injections ranged from 0.1 to 1.0 ml, and erections lasted from 15 minutes to 8 hours. 72% of the patients continued autoinjection during a mean follow-up of 9.9 months and were satisfied with the results. There were 5 cases of corporal fibrosis, and 3 cases had prolonged erections, usually after the papaverine test. The method is simple and inexpensive, and allows many impotent men to resume sexual life. It is a good alternative to the insertion of a penile prosthesis.

Clinical radiological management of an uncommon perinephric abscess

The authors describe an uncommon case of a huge perinephric abscess with a gas-fluid level occupying the upper left abdomen. A rational sequence of radiological diagnostic methods such as plain film, ultrasound, CT, and combined retrograde urogram with contrast filling of percutaneous drainage led to correct management.

Effect of distilled water and bacillus Calmette-Guérin on exfoliated bladder tumor cells

The effect of distilled water on exfoliated tumor cells from transitional bladder carcinoma was compared to the effect of bacillus Calmette-Guérin (BCG; a nonspecific immunotherapeutic agent) dissolved in either saline or distilled water. The experiment was controlled by comparison to the effect of saline on tumor cells under the same conditions. Distilled water proved as effective as BCG in distilled water (p less than 0.001) and much more destructive than BCG in saline within the 2-hour time limit of the experiment (p less than 0.001).

Renal extramedullary hematopoiesis simulating hypernephroma

We report a 63-year-old woman who presented with anemia and a left kidney mass. Guided fine-needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary operation. Subsequent bone marrow biopsy demonstrated myelofibrosis. Twenty-four months later the mass remained stable.

Incomplete quadruplication of urinary tract with contralateral agenesis of the kidney

We describe here the first case of an exceptional anomaly consisting of an incomplete quadruplication of the urinary tract in a solitary left kidney. A review of the English literature failed to document such a case.

An operation for incisional lumbar hernia

To date, no standard technique for incisional lumbar hernia repair can be recommended since it depends on the size of the defect in the transversalis fascia. A new technique for this purpose, by using plication of the normal fascia, is described.

Transitional cell carcinoma of distal female urethra

A rare case of carcinoma of female urethra from transitional cell origin is reported. The occurrence of primary transitional cell carcinoma in the urethra is being discussed, with review of the literature.

Quantitation of renal uptake of technetium-99m DMSA using SPECT

Quantitative single photon emission computed tomography (SPECT) methodology based on calibration with kidney phantoms has been applied for the assessment of renal uptake of [99mTc]DMSA in 25 normals; 16 patients with a single normal kidney; 30 patients with unilateral nephropathy; and 17 patients with bilateral nephropathy. An excellent correlation (r = 0.99, s.e.e. = 152) was found between SPECT measured concentration and actual concentration in kidney phantoms. Kidney uptake at 6 hr after injection in normals was 20.0% +/- 4.6% for the left and 20.8% +/- 4.4% for the right. Patients with unilateral nephropathy had a statistically significant (p less than 0.001) low uptake in the diseased kidney (7.0% +/- 4.7%), but the contralateral kidney uptake did not differ from the normal group (20.0% +/- 7.0%). The method was especially useful in patients with bilateral nephropathy. Significantly (p less than 0.001) decreased uptake was found in both kidneys (5.1% +/- 3.4% for the left and 6.7% +/- 4.2% for the right). The total kidney uptake (right and left) in this group showed to be inversely correlated (r = 0.83) with serum creatinine. The uptake of [99mTc]DMSA in single normal kidney was higher (p less than 0.001) than in a normal kidney (34.7% +/- 11.9%), however, it was lower than the total absolute uptake (RT + LT = 41.5% +/- 8.8%) in the normal group. The results indicate that SPECT is a reliable and reproducible technique to quantitate absolute kidney uptake of [99mTc]DMSA.

Absence of peripheral-type benzodiazepine binding sites in renal carcinoma: a potential biochemical marker

In an attempt to identify a tumour marker, we investigated peripheral-type benzodiazepine binding sites (PBS) in kidney specimens obtained from patients who underwent nephrectomy due to a renal mass. [3H]PK 11195, an isoquinoline carboxamide derivative, was used as a ligand. Binding assays were conducted on samples of membrane homogenate taken from both the healthy portion and the tumour site of the kidney. It was found that binding characteristics of benign tumours and normal kidney tissues were not significantly different, i.e. equilibrium dissociation constants of 2.20 +/- 0.73 and 2.38 +/- 0.98 nM, respectively, and maximal number of binding sites of 3190 +/- 1081 and 4189 +/- 998 fmol/mg protein, respectively. In contrast, no PBS were detectable in renal carcinoma. The absence of PBS in malignant renal tissues may serve as a biochemical marker for tumours of the kidney.

Adrenal myelolipoma simulating virilizing adrenal tumor

We describe a case of adrenal myelolipoma that simulated clinically and biochemically a virilizing adrenal tumor. The tumor was removed surgically. The preoperative diagnosis of adrenal myelolipoma can be made by the characteristic appearance on ultrasonography, computerized tomography and in equivocal cases by guided needle biopsy.

The relationship between clinical stage, natural killer activity and related immunological parameters in adenocarcinoma of the prostate

Several immunological in vitro tests were performed on peripheral blood mononuclear cells of patients with adenocarcinoma of the prostate, stages A, B, C, D. The cytotoxicity of effector natural killer cells towards K-562 targets decreased with increasing disease spread, while their percentage was not significantly changed. The proportion of CD4 (helper/inducer) cells tended to fall with tumor advance, but the proportion of CD8 (suppressor/cytotoxic) cells remained almost constant. Secretion of interleukin-2 from peripheral blood mononuclear cells was diminished with disease progression. Pretreatment of a patient's lymphocytes with cimetidine (antagonist of H-2-bearing suppressor T cells) or indomethacin (inhibitor of prostaglandin synthesis) enhanced natural killer activity. Our data point to the existence of aberrant immune functions in early stages of carcinoma of the prostate and to aggravation of these immune abnormalities in advanced disease.

A safe surgical technique for the infradiaphragmatic removal of caval tumor thrombus complicating renal cell carcinoma

The management of patients with renal cell cancer extending to the vena cava is controversial and challenging. Careful planning of the operative procedure, adequate exposure, complete mobilization of the retrohepatic vena cava and control of the hepatic venous effluence will allow patients with retrohepatic vena caval occlusions to be managed safely and successfully. The major advantage of this technique is the minimizing of both peroperative bleeding and circulatory and biochemical disturbances of the liver due to the interruption of the blood flow.

Fracture of double-J ureteric stents: a report of two cases

Two cases are reported of fracture of the double-J ureteric stent during its prolonged placement for extracorporeal ultrasound shock wave lithotripsy (ESWL). The causation of such fracturing is discussed and it is recommended that double-J stents employed in long-term ESWL be renewed within 5 months of their initial placement.

Preoperative prediction of results of prostatectomy by a symptom score and radionuclide uroflowmetry

A review of preoperative and postoperative symptom scores and radionuclide uroflowmetry in patients undergoing prostatectomy for benign prostatic hyperplasia indicates that there may be certain findings that can help to predict postoperative results. A statistically significant difference was obtained comparing the postoperative results of the symptom score and radionuclide uroflowmetry with the results obtained preoperatively. The correlation between the preoperative ejection fraction and the postoperative total symptom score and irritative score showed a good correlation.

Induction of anesthesia with propofol in urological outpatient surgery

Propofol (Diprivan) in a new formulation, a short-acting intravenous anesthetic, was used as an induction agent for short urological procedures. Forty unpremedicated patients were treated with either propofol or thiopental in a randomized study. The onset of anesthesia and duration of apneic period were prolonged and the decrease in systolic blood pressure was more profound in the propofol group. Heart rate was less stable and recovery time was longer in the thiopental group. Other parameters, such as quality of anesthesia, acceptability of the drug or rate of side effects, were similar in both groups. These results suggest that propofol in a new formulation is a suitable agent for short urological procedures in outpatient surgery.

The use of distilled water as an irrigating fluid in patients undergoing transurethral resection of the prostate

Thirty patients undergoing transurethral resection of the prostate using distilled water as an irrigating fluid were studied. There was no significant change in the serum concentration of the variables studied (preoperatively compared to postoperatively) as possible indicators of haemolysis or absorption of irrigating water such as sodium, potassium, albumin, total protein, creatinine, uric acid, urea, haemoglobin, haematocrit and haptoglobin. The mean value of plasma haemoglobin (P-Hb), observed immediately postoperatively and reflecting the magnitude of haemolysis, was delta 294.8 mg/l. There was a good correlation between P-Hb and the inflowing irrigating distilled water (r = 0.69). The P-Hb variation (delta) correlated with resection time and with the weight of the resected prostate (r = 0.54 and r = 0.52, respectively). A good correlation was also found between resection time and delta body weight which reflects the amount of water absorbed (r = 0.67) and between delta body weight and the inflowing irrigating water (r = 0.61). Our study shows that distilled water can be used as an irrigating fluid quite safely. The advantages of distilled water outweigh the disadvantages which can be avoided easily if proper attention is given.

Paratesticular papillary mesothelioma

A case of uncommon paratesticular mesothelioma in a young patient is presented. Its questionable malignancy, as well as the method of treatment are discussed.