Viral etiology of testicular tumors.

Testicular carcinoma and Hodgkin's disease are among the most frequent malignancies afflicting young men in the 15 to 39-year age group. These malignancies share other epidemiological characteristics as well, including multiple histological tumor types, higher rates of occurrence in white, urbanized populations and upper social classes, relative infrequency among black populations, low but definite familial occurrence and an early geographically acquired lifetime risk irrespective of later migration. Both diseases are increasing in this country. This epidemiological similarity suggests exposure to an infectious agent early in life. The Epstein-Barr virus is known to be oncogenic and neonatal exposure with early infection is believed to be associated with Burkitt's lymphoma in African children. High titers of antibodies to the Epstein-Barr virus capsid antigen also have been reported in a series of studies comparing patients with Hodgkin's disease and controls. Because testicular cancer is epidemiologically similar to Hodgkin's disease and, therefore, might be expected to manifest similar Epstein-Barr virus findings, we performed a viral screen (Epstein-Barr virus, cytomegalovirus, and hepatitis A and B viruses) on blood samples from 56 consecutive patients with clinical stage I germ cell tumors of the testis who had received no active therapy after orchiectomy. Our results show a high incidence (80 per cent) of previous exposure to Epstein-Barr virus and support the hypothesis of a possible infectious origin for testicular carcinoma.

Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome.

A computer-assisted review identified 184 patients with genitourinary tract injuries among 5,400 hospitalized for trauma. Particular attention was directed to the controversial groups of patients with blunt renal and posterior urethral injuries. Management of renal injuries was based on clinical criteria. Subsequent renal exploration was necessary in only 1 of 115 patients with renal contusions, or simple or deep lacerations who underwent initial expectant management. Followup was available in all patients with severe renal injuries and in 53 per cent with renal contusions or simple lacerations. Parenchymal loss was noted on an excretory urogram in only 1 patient and none suffered hypertension, hydronephrosis or other sequelae. A staged approach was preferable to immediate repair of posterior urethral injuries. Seven patients managed by initial cystostomy drainage followed by secondary urethral repairs did well. Primary realignment was complicated by stricture, incontinence or impotence in 3 of 6 patients.

Experimental study of ureteral calculus disease: effects of calculus size, obstruction and hydration.

A chronic canine model was developed to study the immediate mechanical effects of ureteral calculi. Totally implanted nephrostomy tubes were used to measure renal pelvic pressure and optical sensors recorded ureteral activity. Surrogate calculi were inserted in a retrograde fashion via a trigonal vesicostomy. Complete obstruction was more common with larger calculi and these all passed spontaneously, by which time ureteral activity had ceased. Reduction in urine output delayed the rise in renal pressure and thus prolonged the time the calculus was retained in the ureter. If large calculi, which normally obstruct, had holes drilled in them to allow free urine flow they remained in the ureter for at least 2 hours and had to be extracted. Therefore, in the first few hours increased proximal hydrostatic pressure was the most important factor responsible for the spontaneous passage of obstructing calculi.