Partial colectomy required for resection of renal cell carcinoma: a case report and review of treatment options for locally advanced disease.

Because it is more commonly discovered as a result of an incidental finding on radiologic studies, renal cell carcinoma is being diagnosed at earlier stages. Patients still, however, present occasionally with locally advanced disease. Such a case is presented in a patient who required a partial colectomy at the time of radical nephrectomy to remove all of his disease. Also reviewed is the current state of treatment options available for renal cell carcinoma, including chemotherapy, radiation therapy, immunotherapy, and surgery. Despite advances in some of these areas, the mainstay of treatment for locally advanced renal cell carcinoma remains surgery.

The effect of antimicrobial therapy on testicular aspirate flow cytometry.

Many antibiotics have been shown to have adverse effects on spermatogenesis. Deoxyribonucleic acid (DNA) flow cytometry of testicular aspirate has been shown to be an effective method of quantitatively evaluating testicular function. To assess this problem, DNA flow cytometry of testicular aspirate was performed on 8 groups of rats, each of which received antibiotics via daily gavage for 10 days. Aspirations were performed on days 0, 11 and 56. Data thus obtained were analyzed using a two-way ANOVA with repeated measures. Antibiotics studies included ciprofloxacin 15 mg./kg./day, sulfamethoxazole (SMX) 20 mg./kg./day (with trimethoprim (TMP) 4 mg./kg./day), nitrofurantoin 7 mg./kg./day, ofloxacin 10 mg./kg./day, lomefloxacin 6 mg./kg./day, doxycycline 3 mg./kg./day and norfloxacin 10 mg./kg./day. One group received the same SMX/TMP dose, together with folate 0.014 mg./kg./day. A statistically significant change in aspirate content on day 11 as compared with baseline existed in groups receiving TMP/SMX (p = 0.00025), nitrofurantoin (p = 0.0000043), ofloxacin (p = 0.000075) and doxycycline (p = 4.89 X 10(-9). Control rats and the group receiving TMP/SMX with folate showed no significant change. On day 56 the abnormality persisted in groups TMP/SMX (p = 0.042), nitrofurantoin (p = 0.001), ofloxacin (p = 0.036) and doxycycline (p = 0.003). Controls and groups receiving ciprofloxacin, norfloxacin and lomefloxacin continued to show no statistically significant difference from baseline on day 56. These data suggest that SMX/TMP, nitrofurantoin, ofloxacin and doxycycline significantly alter spermatogenesis. Ciprofloxacin, norfloxacin and lomefloxacin had no apparent effect on spermatogenesis as measured by DNA flow cytometry.

Response of renal intrahilar retroperitoneal fibrosis to immunosuppressive therapy.

We report the case of a 37-year-old woman who developed renal failure secondary to obstruction by renal intrahilar retroperitoneal fibrosis. Her disease proved to be sensitive only to high-dose immunosuppression. Our case illustrates an unusual course of this disease and the role of immunosuppression in its management.

Recent advances in the diagnosis and treatment of renal arteriovenous malformations and fistulas.

Arteriovenous malformations remain relatively rare clinical lesions. However, with an increasing number of percutaneous renal procedures being performed, their overall incidence can be expected to increase. Congenital arteriovenous malformations usually present with hematuria, while acquired fistulas are more likely to present with hemodynamic changes, such as hypertension, cardiomegaly and congestive heart failure. Arteriography remains the principal method of diagnosis. However, newer imaging modalities such as CT, MRI and color duplex ultrasound may make significant contributions in the evaluation of these abnormalities (fig. 1). Surgery, whether nephrectomy or ligation of feeding vessels, has long been the standard treatment for symptomatic arteriovenous malformations or fistulas. The loss of normal renal parenchyma, migration of occluding agents or recanalization of abnormal vessels has limited the use of embolization as a method of treatment in the past. Recently, newer techniques and agents, such as pharmacoangiography and alcohol, have increased the efficacy of embolization therapy, either as an adjuvant to surgery, definitive therapy or palliation. Although to our knowledge there have been no controlled studies comparing surgical treatment versus embolization, certain recommendations can be made. Because of the decreasing morbidity and increasing efficacy, embolization should be attempted at the time of arteriography as a means of treatment for most arteriovenous malformations and fistulas. However, the choice of surgery, embolization or a combination must be individualized for each patient with regard to overall health, symptoms and manifestations of the fistula or malformation (fig. 2).

Bilateral single ectopic ureters: diagnosis using transrectal ultrasound.

An unusual case of bilateral, single ectopic ureters inserting into the prostate gland presenting with hydronephrosis and renal insufficiency is reported. The diagnosis was made by transrectal and abdominal ultrasound.