Unexpected urinary Schistosoma infection in a Belgian travel group returning from Malawi.

Urinary schistosomiasis, caused by Schistosoma haematobium, is a prevalent parasitic infection in certain areas of Africa and the Middle East. Humans can be infected by cercariae when they are in contact with contaminated freshwater. The adult worms reside in the veins of the vesical and pelvis plexuses. The urinary bladder, the seminal vesicles and the lower ends of the ureters are the most commonly affected organs. In this case report, we describe an unrecognised case of urinary schistosomiasis in a woman who was part of a Belgian travel group; two other patients out of eight were also infected. In Belgium, the number of reported cases of S. haematobium infection is limited. The aim of this report is to emphasize this parasitic infection should be suspected in patients who travel to endemic areas.

Tertiary syphilis presenting as hepatic bull's eye lesions.

We report a rare case of tertiary syphilis (hepatic gummata, asymptomatic neurosyphilis and iridocyclitis) in a 47 year old female patient. Our patient suffered from a troubled sight, pain in the right hypochondrium, one enlarged submandibular lymph node, an elevated sedimentation rate, disturbed liver tests and two hepatic lesions upon abdominal computed tomography. The diagnosis was based upon a liver biopsy and a positive Treponema Pallidum haemagglutination test. The patient was treated with doxycyclin. After treatment the sedimentation rate and liver tests normalised and the hepatic lesions disappeared leaving a small 'scar' on CT-scan; at the end she still complained of a decreased sight. We conclude that syphilitic gummata of the liver have a favourable prognosis when the diagnosis is made early. One has to differentiate with hepatic abscesses, primary tumours and metastases.

Focal transmural necrosis of the gallbladder with bleeding resulting in a massive haemoperitoneum.

A case of massive haemoperitoneum as a complication of focal transmural necrosis of the gallbladder with bleeding during acute cholecystitis is reported. Urgent laparotomy and cholecystectomy was performed to secure an adequate haemostasis. A review of the literature confirmed that this condition is a very rare complication of acute cholecystitis. Only 44 similar cases have been reported between 1858 and 1996. In our case, bleeding was caused by the edges of a necrotic zone in the gallbladder wall.

Ureteral stump metastasis from renal adenocarcinoma: case report and literature review.

The occurrence of metastasis along the ureteral stump after previous radical nephrectomy for renal adenocarcinoma is very rare, only 47 cases having been reported in the literature. We present a case of metastasis of renal adenocarcinoma, occurring in the ureteral remnant, more than three years after ipsilateral radical nephrectomy. The analysis of this and previously reported cases leads us to propose radical nephro-ureterectomy as treatment of choice in certain cases of renal adenocarcinoma, instead of radical nephrectomy alone, notably when preoperative urine-cytology shows the presence of adenocarcinoma cells, and/or when vascular tumor infiltration is present. This adjuvant surgical step is of course only justified in those cases where a reasonable life-expectancy is present at the time of diagnosis, and thus especially applicable in the smaller T2 tumor group.

Experience with the Leeds-Keio artificial ligament for anterior cruciate ligament reconstruction.

Artificial anterior ligament reconstruction was very popular between 1975 and 1990. Recently, disappointing results have been published. We reviewed 68 patients who had received an artificial anterior cruciate ligament reconstruction 1 year and 5 years after their operation. The Leeds-Keio device was used as a scaffold. The ligament failed in 32 knees. This was arthroscopically confirmed in 20 cases. The other 12 knees were grossly unstable, with a reappearance of pivot shift, anterior drawer sign and high KT 1000. Generally, we found a marked increase in laxity over the period of investigation. Several biopsies were taken during arthroscopic examination of suspected ruptures. They showed lack of collagenisation and ingrowth.

Idiopathic calcinosis of the scrotum: scanning electron microscopic study with X-ray microanalysis.

In a 31-year-old man 12 nodules up to 1 cm in diameter were observed in the scrotum; these had developed over 3 years. Energy-dispersive x-ray analysis of the dermal foci showed a high content of calcium and phosphorus even in nodules smaller than 1 mm in diameter. No increased mineral deposition was observed in the surrounding connective tissue, however. Scanning electron microscopy revealed finely granulated crystals, and cellular remnants giving rise to development of calcified nodules were disclosed. The results support the hypothesis of a degenerative origin of scrotal calcinosis.

Signet ring cell carcinoma in adenomatous polyp at site of ureterosigmoidostomy 16 years after conversion to ileal conduit.

The case of a signet ring cell carcinoma of the colon arising in an adenoma at the site of ureterosigmoidostomy after conversion to an ileal conduit is reported. Urine exposure to the colonic mucosa was present only for a short period before development of an adenoma with subsequent signet ring cell carcinoma transformation more than 15 years later. In the face of recent reports on adenocarcinoma in cases of bladder substitution or augmentation without any possible promoting influence of the fecal stream, the well known risk of neoplasia after sigmoidostomy remains unclear in its etiology.

Proliferation kinetics-study of the growth of keratocysts. Morpho-functional explanation for recurrences.

The mode of growth of the odontogenic keratocyst is of decisive importance in the strategy and radicality of its surgical removal. The high rate of recurrence reported in the literature is striking. Staining with haematoxylin-eosin for histological examination provides only limited information on growth. Serial sections of a keratocyst obtained by fractionated curettage were prepared and the proliferation patterns of epithelium and connective tissue were studied by means of autoradiography and DNA cytophotometry and compared with those of an odontogenic reference cyst of the radicular type. The epithelium of the keratocyst examined clearly showed a higher rate of proliferation than that of the radicular cyst. The connective tissue was also growing very actively with a high rate of proliferation and this growth behaviour is at least partly responsible for the invasive and destructive growth of the keratocyst. In contrast to the radicular cyst, proliferation of the epithelium of the keratocyst is multicentric being simultaneous within the growth centres. As a result the epithelium "buds" with formation of satellite cysts in the alveolar bone and peripheral epithelial islands located in the connective tissue. A case is reported of a keratocyst treated by radical curettage with subsequent freshening of adjacent bone with a bur. Our morphological findings are an important contribution to the present discussion of the various methods of treating keratocysts.

Fine needle aspiration biopsy of myxoid variant of malignant leiomyoblastoma metastatic to the liver.

The cytologic features seen in a fine needle aspiration biopsy specimen of a liver metastasis from a myxoid variant of a malignant leiomyoblastoma (epithelioid leiomyosarcoma) of the stomach are presented. The abundant mucus production and rich vascularity evident in the aspiration smears corresponded to the histologic findings in the original tumor, which had been excised two years previously. Histochemical and immunochemical staining were used to substantiate the smooth-muscle origin of the tumor.

Natural history and treatment of low and high risk superficial bladder tumors.

Since 1979 a prospective randomized trial was done to examine the efficacy of intravesical doxorubicin as prophylaxis against recurrence. After complete transurethral resection of the tumor, patients were divided into 3 groups at random: group 1-no further treatment after transurethral resection, group 2-doxorubicin twice weekly for 6 weeks and group 3-doxorubicin for 1 year. A total of 268 patients entered the study. Neither frequency of recurrences, tumor progression nor survival rate was improved significantly by the adjuvant treatment, so that only a limited number of patients will profit by instillation therapy. Analysis of previously reported data suggests that patients with superficial bladder tumors can be stratified into groups with appreciable differences in risk of progression. With regard to these results a differentiated use of a "wait and see" adjuvant intravesical therapy and more aggressive treatment after transurethral resection of superficial bladder tumors seems to be indicated rather than a general practice of chemoprophylaxis.

Melanocytic neuroendocrine carcinoma of the thymus.

A neuroendocrine carcinoma of the thymus with an ectopic adrenocorticotropic hormone (ACTH) syndrome and melanocytic differentiation is described. ACTH, neuron-specific enolase (NSE) and S-100 protein were identified in the tumor by immunocytochemistry. Neurosecretory granules and melanosomes could be demonstrated in different cell populations by electronmicroscopy. The clinicopathologic findings are presented. The literature is briefly discussed.

[Various staining procedures in exfoliative urine cytology. Use in routine urology]. / Unterschiedliche Färbeverfahren der exfoliativen Urinzytologie. Anwendung in der urologischen Routine.

Exfoliative urinary cytology should be included in the diagnostics and follow up of bladder carcinomas. Staining according to Papanicolaou is time consuming and expensive. Therefore the accuracy of cytology after methylene blue staining, use of prestained slides and Papanicolaou staining was investigated. Urine and bladder washouts were taken from 77 patients with histologically proven bladder tumors, 152 patients after resection of the tumor and 100 patients without tumor of the urinary tract. The results show comparable accuracy of the different staining techniques. Methylene-blue stained and prestained slides cannot be used for documentation; therefore all specimens, which show tumor or are suspicious should also be stained according to Papanicolaou.

Opportunities to Improve Milk Quality.

Many opportunities exist to improve the bacterial quality of milk, particularly of manufacturing-grade milk. Test results, using plate counting procedures by 10 Iowa dairy laboratories, reflect a gradual improvement in recent years in manufacturing-grade milk quality. In recent months, 70 to 84% of 3,000 to 5,000 individual Iowa farm's manufacturing-grade milk samples tested each month were placed in Class I (plate-loop count of less than 500,000/ml). Problems still exist in farm milking equipment sanitation, undersized bulk tanks with inadequate cooling capacities, and delays in processing raw milk. USDA DMCC results on milk samples obtained from milk-storage tanks in Iowa dairy manufacturing plants reveal that in 1977-78 only 5.8 to 13.1% of the commingled raw milk would be classified as Class I. These results reflected a deterioration in bacterial quality of raw milk from the time milk leaves the farm until held in the plant storage system. Part of the quality deterioration can be blamed on failure to empty and clean plant storage tanks often, allowing too much time before milk is processed, and on milk not at 40 F or less. Cheese and butter exhibits reveal that poor milk quality has a negative influence on product flavor quality. Quality assurance programs for dairy farms, milk transportation, and plant storage must stress sanitation, cold temperatures and minimum times before processing to obtain good bacteriological quality milk and pleasing-flavored dairy foods.

The 3M Automatic Colony Counter in the Bacterial Evaluation of Manufacturing-Grade Milk.

Twenty-seven raw milk samples were analyzed for their bacterial quality by the Standard Plate Count (SPC) and the plate loop count (PLC). All resultant plates were counted by three different technicians either manually or with a 3M Brand Automatic Colony Counter, Model 630. Results emphasize the superiority of the SPC over the PLC for samples with high bacterial numbers. The automatic colony counter tended to underestimate the number of colonies on a plate. Correction factors for conversion of PLC counts to SPC and automatic to manual counts were calculated. It is recommended that the PLC and the automatic colony counter be used with appropriate correction factors for routine analysis of large numbers of samples.