Retroperitoneal fibrosis. A follow-up study.

13 patients with retroperitoneal fibrosis (RPF) were reviewed. 10 patients had idiopathic disease and in 3 patients the disease was secondary to temporal arteritis, aortic aneurysm and ergotamine ingestion. Ureterolysis was performed in all patients. 4 patients were reoperated due to problems arising from RPF progression. A total of 24 ureters were lysed. 23 of these functioned in the early postoperative period. 22 ureters were available for follow-up 4 months to 20 years later. 19 kidneys had a free outflow, 2 kidneys were removed and 1 left in situ without function. A review is presented on the etiology, pathogenesis and treatment of this disease. Percutaneous nephrostomy is recommended when the patient presents with severely elevated plasma creatinine, pyonephrosis or urosepsis.

Diagnosis of hyperparathyroidism in patients with urolithiasis using measurement of serum immunoreactive parathyroid hormone and serum calcium.

Serum immunoreactive PTH (iPTH) was measured in 74 patients with urolithiasis and correlated to the corresponding serum calcium values. Serum iPTH was measured using a rooster antibovine iPTH antiserum which crossreacted with the human hormone within the 44-68 amino acid residue region. Sixty-six of these patients had normal serum iPTH and calcium concentrations. Their calcium values varied from 2.2 mmol/l to 2.6 mmol/l and their serum iPTH concentrations were less than 0.6 micrograms/l. The remaining 8 patients with urolithiasis were judged to have primary hyperparathyroidism because of an abnormal iPTH/calcium relationship. These patients had serum calcium concentrations varying from 2.6 mmol/l to 3.4 mmol/l and iPTH concentrations between 0.35 micrograms/l and 3.03 micrograms/l. The diagnosis was verified histologically in 7 patients after operation. In the last patient iPTH was reduced from 1.01 micrograms/l to 0.21 micrograms/l after surgery, and serum calcium changed from 2.6 mmol/l to 2.2 mmol/l. The combined evaluation of serum iPTH and calcium may improve the diagnosis for hyperparathyroidism and was in our series helpful in making a correct diagnosis in 2 out of 7 patients who had histologically verified disease. In addition, iPTH measurements are valuable to rule out hyperparathyroidism as the cause of hypercalcaemia.

Sigmoidocystoplasty in adults with enuresis.

Sigmoidocystoplasty was performed upon 13 adult patients with enuresis to increase the small bladder capacity. Eleven patients were in the follow-up study. The mean observation time was 29.5 months with a range from 13 to 66 months. Ninety per cent of the patients were satisfied with the result.

Endocrine tumors of the pancreas.

A review of 33 patients operated on between 1951 and 1978 for endocrine tumors of the pancreas is presented. The series consists of 25 patients with hyperinsulinism, 6 with the Zollinger-Ellison syndrome, and 2 with the WDHA syndrome. Clinical features and diagnostic problems are discussed. A noticeable feature is that the average time lapse between onset of symptoms and final diagnosis in insulinoma patients has not been significantly reduced during the years covered by this review. This is in spite of the progress made in testing procedures and laboratory methods designed to diagnose hyperinsulinism. Resection of the tumor has been the preferred treatment in insulinoma patients, of whom 22 are still alive. Insulinomas were associated with other endocrinopathies in 3 cases. Patients with the Zollinger-Ellison syndrome had raised serum gastrin levels and increased basal acid output. Four patients are still alive. Two patients had other endocrinopathies. Both patients with the WDHA syndrome died shortly after the operation. One had biochemical evidence of multiple endocrinopathies.

Total replacement of the ureter with a segment of ileum. A follow-up study.

Total replacement of the ureter with a segment of ileum was performed on seven patients. Five of them were followed up for a mean of 20 months. The results of the operation were good. Serum electrolyte imbalance occurred postoperatively in one case.

Sigmoidocystoplasty: a follow-up study.

Sigmoidocystoplasty was performed in 62 patients. 36 were followed up. The mean observation period was 68 months, ranging from 6 to 318 months. In 18 patients the results were considered as good, 11 were improved after the operation and in 6 cases the situation was unchanged. The importance of normal urine outflow and postoperative urine cultures is emphasized.

Probable endometrial carcinoma of the prostate, crossed renal ectopia and dermatomyositis in a 32-year-old man.

An unusual type of prostatic carcinoma associated with crossed renal ectopia and dermatomyositis is reported in a young man. Infiltration by an epithelial tumor filled the enlarged prostate with soft papillary masses. Cystoprostatectomy and removal of a single large pelvic lymph node metastasis were done. Histologically, the tumor resembled endometrial carcinoma and may have arisen from paramesonephric tissue in the prostate. Large amounts of immunoglobulins were found in the tumor tissue. The patient has survived for more than 5 years, although a slow growing urethral recurrence has been noted.

A test of the sympathic nervous system of the urethra.

The administration of 5 mg phentolamine by a new technique decreases the urethral closure pressure by 38%. The latter could be used as a test for the sympatic nervous system in the urethra.

Air cystometry at different flow rates.

Air cystometry was performed with 3 different flow rates in patients suffering from different bladder diseases. To demonstrate neurogenic bladder disorder a flow rate of 75 ml/min was recommended.

Recto-urethral fistula. Treatment by abdomino-perineal pull-through resection of the rectum.

4 patients with difficult and longlasting recto-urethral fistulas were treated by abdominoperineal pull-through resection of the rectum. Primary closure of the fistula occurred in all cases. We suggest that this operative technique should be taken into consideration in cases of difficult rectourthral fistulas.