Fournier's gangrene of scrotum in a patient with AIDS

Fournier's gangrene of the scrotum, a form of necrotising fasciitis, is a rare but potentially fatal disorder. Predisposing conditions include chronic alcoholism and diabetes mellitus, possibly as a result of impaired immunity. Fournier's syndrome, occurring in a patient with AIDS, is described.

Water contamination in North Cornwall: a retrospective cohort study into the acute and short-term effects of the aluminum sulphate incident in July 1988

IN JULY 1988 the drinking water supply of part of Cornwall was contaminated with 20 tons of aluminum sulphate solution. Emergency measures ensured that aluminum sulphate levels in most parts of the water distribution system were rapidly reduced, but residents were supplied with water containing raised concentrations of aluminum and other metals for at least a few days. A retrospective cohort study compared 480 individuals in the exposed area with 532 individuals resident in an area served by a different water supply. The exposed group were more likely to complain of all 18 symptoms in the questionnaire enquiry. They had a significantly higher relative risk of experiencing painful joints. These symptoms were reported by less than a quarter of the respondents exposed to contaminated water. This may represent a previously unrecognised acute effect of water contamination with aluminum sulphate, but the study does not exclude the possibility that the threshold for symptom reporting was lowered by anxiety and by the publicity associated with the incident. The overall response rate of the study was low (45%) and reflects the difficulties in both carrying out and interpreting environmental epidemiological studies of acute incidents.

Use of the double pigtail stent in stone retrieval following unsuccessful ureteroscopy

Insertion of a double pigtail stent is known to cause ureteric dilatation. We analysed the effect of an indwelling double pigtail stent on the success rate of calculus extraction by second ureteroscopy when the initial ureteroscopy fails. Over a 12-month period, a first ureteroscopy failed in 42 patients; 30 were then treated by ureteroscopy combined with a ureteric stent and 12 were treated without a ureteric stent. The group with an indwelling stent had a successful second ureteroscopy or spontaneously passed the calculus in 24 cases (84%) compared with 5 unstented cases (45%). Ureterolithotomy was necessary in 2 patients with a stent and 3 with no stent. It was concluded that following failed ureteroscopic manipulation of calculi, insertion of a double pigtail stent was associated with a higher subsequent success rate for removal of stone by ureteroscopy and a consequent lower rate of ureterolithotomy.

Urothelial carcinoma occurring within an inverted papilloma of the ureter

Only 5 cases of inverted papilloma of the ureter with a malignant component have been reported previously. We add case 6 to the literature. The incidence of concomitant malignancy in ureteral inverted papillomas is 3 times that found in similar lesions occurring in the bladder.

Endoscopic treatment of urinary tract calculi

Removal of urinary tract calculi by endourological techniques is now widely practised and has reduced the indications for open surgical removal to a minority of cases. A review of 270 consecutive patients who presented to the Meath Hospital Urology department with urinary tract calculi and were treated by percutaneous or transurethral endoscopy is herein reported. The rates of successful clearance of renal (95%) and ureteric (78%) calculi compare well with previous reports. The majority of complications were minor and a low overall complication rate was experienced at ureterorenoscopy. In our experience, endourological treatment of urinary tract calculi is successful, efficient and safe and is the recommended approach to urinary tract calculi that require surgical intervention.

Bilateral ureteric carcinoma

We report two rare cases of bilateral simultaneous ureteric carcinoma. The radiological features and problems of management are discussed.

Primary amyloidosis of lower urinary tract

Primary amyloidosis of the lower urinary tract is a rare condition with an excellent prognosis in most cases. Three patients with this condition are described. In the cases of localized amyloidosis of the urethra and urinary bladder, the clinical presentation mimicked cancer of the respective sites. This was also true in the case of primary systemic amyloidosis involving the bladder. If significant associated systemic or local disease can be excluded, management is symptomatic and expectant.

The sapphire crystal infrared photocoagulator and polyglactin (Vicryl) mesh: two new alternatives to the suturing of radial nephrotomies

The sapphire crystal infrared photocoagulator and polyglactin (Vicryl) mesh, two new methods for closure of radial nephrotomies, were assessed in 16 dogs. Six radial nephrotomies were carried out in each dog; in 10 the nephrotomies were sealed by the infrared photocoagulator and in six they were left open, but the kidney was covered with a polyglactin mesh. Functional and morphological studies were performed using creatinine clearance, microfil casting, corrosion cast angiography and histology. There was no significant loss of function or loss of renal tissue. Both methods were shown to be safe and effective in the closure of radial nephrotomies.

Calcium excretion in metastatic prostatic carcinoma

In 64 men with prostatic carcinoma, calcium excretion per litre of glomerular filtrate (Cae) was persistently lower in those with bone secondaries than in those with soft tissue involvement only, despite a normal range of serum calcium in both groups. In three patients who showed an improvement in their bony metastases on bone scan 6 months after starting treatment, the Cae values had increased slightly but still remained in the low range. In a further five who showed no improvement on bone scan, Cae values were lower than before. In patients with prostatic carcinoma, Cae is an indicator of early changes in calcium homeostasis. It may also provide an objective indication of progression of bone secondaries.

Use of an automated external defibrillator-pacemaker by ambulance staff

A new portable external device detects ventricular fibrillation and profound bradycardia or asystole by analysis of wave forms; it automatically delivers a defibrillating shock or repetitive pacing stimuli. Ambulance crews used the device on 27 cardiac-arrest patients. The initial group (16) was restricted to patients prejudged as probably beyond successful resuscitation, and none survived. The subsequent group (11) was not restricted. 5 were discharged alive from the hospital. The device is simple to use, and its application by modestly trained technicians and lay people may be feasible. Widespread use of the device as an adjunct to conventional cardiopulmonary resuscitation could reduce mortality from out-of-hospital cardiac arrest. The capability for external cardiac pacing enhances the efficacy of treatment.

Defibrillation at a football stadium: an experiment with Brighton and Hove Albion

Over a five-year period arrangements have been made to increase the prospects of resuscitation for victims of sudden death at a large football stadium. Seven cases of ventricular fibrillation occurred. Four were resuscitated successfully and were subsequently discharged from hospital.