Grading of reflux by radionuclide cystography

Over a three-year period, radionuclide cystography (RC) was performed on 145 patients. Of these, 31 nephroureteral units in 25 patients demonstrated vesicoureteral reflux by RC and also by radiographic cystography (XC). The RC and XC studies were performed within three months of one another. The grading of reflux was determined by RC and then compared with that of XC using the criteria for grading as established by the International Reflux Study Committee (IRSC). Of 18 nephroureteral units in 14 patients with grade II reflux by XC, 14 were similarly graded by RC (78%). Of five nephroureteral units in five patients with grade III reflux by XC, the correlation by RC was 100%. However, when grades II and III were combined into a single category of low-grade reflux, the correlation achieved between the two cystographic techniques was 100%. Of five nephroureteral units in four patients with grade IV reflux by XC, the correlation was 60%, and in three units in two patients with grade V reflux the correlation was 100%. When grades IV and V are combined into a category of high-grade reflux, a correlation of 100% is achieved. When the reflux is graded into the five IRSC categories, the overall unequivocal correlation between the two studies is 80%. However, when only two categories are used (low grade = grades II and III, and high grade = grades IV and V), a correlation of 100% is obtained.

Urinary undiversion: indications, technique and results in 50 cases

We present our experience with reconstruction of the diverted urinary tract in 50 patients divided into 3 groups according to the presence of neurogenic bladder dysfunction, severe renal failure or normally innervated bladders and sphincters with normal renal function. The over-all success rate of anatomical and functional reconstruction was 88 per cent and we expect it ultimately to increase to 94 per cent. However, because of a 2 per cent mortality rate and a 16 per cent major complication rate, we recommend that all other therapeutic options be considered carefully before undertaking urinary undiversion when the reconstruction involves use of intestinal segments.

Cancer of the penis. Prognosis and treatment plans

Sixty-one patients with clinical low-stage (Jackson Stage I) and 22 patients with clinical high-stage (Jackson Stage II or III or T3-4N0-1M0) carcinoma of the penis who were seen between 1952 and 1979 and followed for at least 3 years or until death were reviewed. The majority of patients with Stage I cancer were treated with partial penectomy, either with or without ilioinguinal lymphadenectomy. The remainder of patients with these early small lesions were treated with local excision or circumcision. Forty-one of the patients with this early penile cancer (Jackson Stage I or Tcis, T1N0M0 or T2N0M0) survived at least 3 years and were considered cured. The other 20 patients died of cancer (12 cases) or unrelated disease (8 cases). If the patients who died of other diseases are excluded, the corrected 5-year survival rate was 77%. Treatment failure was primarily due to metachronous inguinal metastases after initial treatment of the primary tumor and failure of response of metastatic disease to salvage treatment. Four factors probably were associated with a poor prognosis: large primary tumor, moderately to poorly differentiated cancer, younger age at onset, and inadequate initial treatment. In advanced (Jackson Stages II and III) disease, treatment by partial or total penectomy alone or in combination with radiation to inguinal nodes after penectomy produced 3-year or longer survival in only 2 of 9 patients, whereas treatment by early extended excision of both the primary lesion and the ilioinguinal lymph nodes produced 3-year or longer survival in 11 of 13 patients. The results suggest that local excision is appropriate only for carcinoma in situ. Partial penectomy and monthly follow-up for at least 1 year is appropriate for patients with small, well-differentiated primary tumors. Patients who have large or moderately to poorly differentiated primary tumors probably should undergo partial or total penectomy and immediate ilioinguinal lymphadenectomy.

Involvement of spot 35 protein, a cerebellar protein, in modulation of Purkinje cell activity of the rat cerebellum

Spot 35 protein, applied iontophoretically, produced inhibition of spontaneous Purkinje cell activity in most cells and augmented the NE- or 5-HT-induced inhibition of spontaneous discharges whereas it hardly affected the inhibitory response of Purkinje cells to GABA, taurine, and beta-alanine, and the excitatory response to glutamate. It is suggested that spot 35 protein may be involved in normal physiological operation of the cerebellum through modulation of the NE or 5-HT system.

Bilateral renal oncocytoma: report of 2 cases and literature review

We report on 2 patients with bilateral renal oncocytoma treated in the last 5 years. One patient underwent bilateral partial nephrectomy for a solitary tumor in each kidney. Both tumors were confirmed to be renal oncocytomas by light and electron microscopic examination. After 4 years this patient had no evidence of local recurrence or distal metastasis. The second patient presented with bilateral multiple renal oncocytomas. Transabdominal bilateral renal exploration revealed 2 tumors in the right kidney and 3 tumors in the left kidney. Right radical nephrectomy and enucleation of the left renal tumors were performed. Examination by light and electron microscopy confirmed that all tumors from both kidneys were oncocytomas. Only 8 cases of bilateral renal oncocytoma have been reported in the literature, including our 2 cases. In 6 of these 8 cases the tumors were multicentric, which may be a characteristic of bilateral renal oncocytoma. Recognizing the coexistence of multicentricity and bilaterality is important because more conservative treatment is required. However, a favorable prognosis may still be anticipated.

Topographical distribution of electroretinographic potentials monitored by skin-electrodes

Electroretinographic recordings were made from 20 different skin points by skin-electrodes when the eye was fixed in a straight forward, lateral and nasal gaze. Three dimensional distributions of the percent amplitude of the b-wave were made using a microcomputer. The best recordings were obtained upon lateral gaze from skin points on the lower eye lid or near the lateral canthus. The skin-electrode ERG recording from these skin points upon lateral gaze may provide a useful diagnostic tool, especially in young children.

The structural analysis of hemoglobin Handsworth

The present paper describes the structural analysis of an abnormal hemoglobin variant of alpha-chain found in a Chinese woman in the Hechi district of the Zhuang Autonomous Region of Guangxi, and finds it to be hemoglobin Handsworth (alpha 18(A16) Gly leads to Arg).