Chronic eccentric cycling improves quadriceps muscle structure and maximum cycling power.

An interesting finding from eccentric exercise training interventions is the presence of muscle hypertrophy without changes in maximum concentric strength and/or power. The lack of improvements in concentric strength and/or power could be due to long lasting suppressive effects on muscle force production following eccentric training. Thus, improvements in concentric strength and/or power might not be detected until muscle tissue has recovered (e. g., several weeks post-training). We evaluated alterations in muscular structure (rectus-femoris, RF, and vastus lateralis, VL, thickness and pennation angles) and maximum concentric cycling power (Pmax) 1-week following 8-weeks of eccentric cycling training (2×/week; 5-10.5 min; 20-55% of Pmax). Pmax was assessed again at 8-weeks post-training. At 1 week post-training, RF and VL thickness increased by 24±4% and 13±2%, respectively, and RF and VL pennation angles increased by 31±4% and 13±1%, respectively (all P<0.05). Compared to pre-training values, Pmax increased by 5±1% and 9±2% at 1 and 8 weeks post-training, respectively (both P<0.05). These results demonstrate that short-duration high-intensity eccentric cycling can be a time-effective intervention for improving muscular structure and function in the lower body of healthy individuals. The larger Pmax increase detected at 8-weeks post-training implies that sufficient recovery might be necessary to fully detect changes in muscular power after eccentric cycling training.

A case of mixed adult Wilms' tumour and angiosarcoma responsive to carboplatin, etoposide and vincristine (CEO).

Here we report an unusual case of mixed Wilms' tumour and angiosarcoma in a 38-year-old female patient who presented with haematuria and right lower back pain. A computed tomographic (CT) scan confirmed a massive renal tumour associated with extensive retroperitoneal lymph node involvement, bony metastases and a right hip fracture. She was initially managed with palliative nephrectomy, which was followed by rapid postoperative deterioration. Histopathology revealed differentiated adult Wilms' tumour with renal angiosarcoma, whereas the pathology of the para-aortic lymph node and bone metastasis revealed angiosarcoma only. In view of her cachexia and cytopaenia, emergency chemotherapy was initiated using a modified regimen of carboplatin, etoposide and vincristine (CEO) in preference to the more traditional but less well-tolerated VAC (vincristine, actinomycin D, cyclophosphamide). Four cycles of this protocol yielded a dramatic response on re-staging CT scan. This case suggests that highly angiogenic tumours such as angiosarcoma may be effectively palliated using agents usually reserved for refractory Wilms' tumour, and supports the view that adult Wilms' tumour is more sensitive to such agents.

Use of the stomach for bladder replacement and urinary diversion.

The current methods of urinary diversion and bladder replacement have many drawbacks. The pyloric antrum of the stomach was chosen for this purpose because of its good blood supply, relatively poorly absorbing mucosa, acidification of urine, and good contractility. This was first tried out in dogs with extremely encouraging results in the form of both bladder replacement and conduits. Since 1969 these techniques have been applied to human clinical use. Extensive postoperative studies have shown that the pyloric antrum functions well in the urinary tract and that its use for bladder replacement and urinary diversion is probably superior to other recognised methods for these purposes.

Chyluria--a 10 year follow-up.

One hundred and sixty-one cases of chyluria have been studied. The possible aetiological factors, the approach to investigation and the methods and results of treatment have been discussed. In this series, the diagnosis was established by the presence of chyle in the urine. Lymphography was carried out in 90 patients for the localisation of the site of lymphatic reflux while cystoscopic examination after fatty meal was useful in determining the side with the heavier leakage. One hundred and nineteen cases responded to conservative treatment and only 42 cases required operative treatment. Stripping of the renal pedicle via the retroperitoneal route gave the best results.

Chyluria: result of surgical treatment in 50 cases.

We treated 50 patients with chyluria by stripping the renal pedicle. Until further studies reveal the etiology of chyluria ligation and stripping of the pedicle remain the treatment of choice and this fact has been borne out by our long-term results.

Clinical study of hemospermia.

Sixty-five cases of hemospermia seen over a ten-year period were reviewed. No specific etiology was disclosed, although renal tuberculosis was seen in 11 per cent of cases, indicating that hemospermia is a self-limiting and benign condition which does not require full urologic investigation.

A lymphographic study of chyluria.

Ninety patients with chyluria were studied by bilateral pedal lymphography. The retroperitoneal lymphatic vessels were dilated, tortuous and increased in number in 61% of cases while the appearance of the lymph nodes was abnormal in 67% of cases. Renal lymphatic reflux, either bilateral or unilateral, was seen in 93% of patients. A correlation (P greater than 0.007) was observed between the site of origin of the cisterna chyli and side of unilateral renal lymphatic reflux. There was no evidence of thoracic duct obstruction although the thoracic duct was more than 3 mm in calibre in seven cases. Lymphography was also performed on 22 patients who had undergone stripping of the lymphatics along the renal pedicle to determine if surgical disconnection was complete. The pathogenesis of chyluria is briefly discussed.

Pelvic exenteration for advanced pelvic malignancies.

Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five-year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.

Asymptomatic phaeochromocytoma of the bladder co-existing with carcinoma.

A case of asymptomatic phaeochromocytoma occurring in co-existence with a transitional cell carcinoma of the urinary bladder is reported and the significant characteristics discussed.

Carcinoma of the renal pelvis: an analysis of the diagnostic problems in 23 cases.

A series of 23 patients with carcinoma of the renal pelvis is presented. The different presentations are described and discussed, and the difficulties in establishing a preoperative diagnosis are considered. There were 3 squamous cell carcinomas in the series, all of them associated with renal stone and urinary tract infection.