Microcoil embolization in post-traumatic high-flow priapism.

An 18-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. Color Doppler ultrasound showed a high-flow arterio-venous fistula with feeders from branches of the left internal iliac artery. Selective arteriography of the left internal pudendal artery demonstrated an arterio-venous fistula. A curved-tip 2.3 French microcatheter (Terumo Medical Corporation, Tokyo, Japan) was advanced proximal to the fistula over a 0.014″ flexible guidewire. The fistula was then embolized with 2 platinum 18-2-2 Hilal Embolization Microcoils (Cook, Bloomington, Indiana). Improvement was noted, with closure of the fistula at check angiography and significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 6 and 12 weeks later, he had normal erectile function. Transarterial embolization appears to be a safe and effective treatment for managing patients with high-flow priapism.

Pattern of metastases in renal cell carcinoma: a single institution study.

BACKGROUND: Increasing numbers of patients with renal cell carcinoma (RCC) are incidentally detected and can be potentially cured by surgery alone. In treating metastatic RCC, worthwhile survival rates are achieved in cases of low burden recurrences. This necessitates a rational follow up protocol, which picks up early recurrences and avoids costly surveillance for those with a favorable prognosis. AIMS: We studied the patterns of metastases occurring in patients operated for localized or locally advanced renal cell carcinoma in the Indian setting and try to evolve a suitable follow up protocol. SETTING AND DESIGN: Institution based, retrospective data. METHOD AND MATERIALS: Records of patients from January 1988 to December 2003, operated for initially localized RCC were reviewed. Follow up was performed using an established protocol. Occurrence of metastases and their patterns were studied. STATISTICAL ANALYSIS USED: Comparison of the different survival times was performed using the one-way analysis method. Multiple comparisons (post hoc test) were performed using the Bonferroni method. RESULT: Follow up was available on 209 patients. Mean survival was 43.75 months (SD +/- 28.72). Thirty-nine patients developed 59 metastases. Lungs were the commonest site of metastases (37%), followed by bone (22%), liver (19%) and brain (8%). Relapse and survival showed significant correlation with pathological stage (p CONCLUSIONS: Occurrence of metastases correlate with the pathological stage of the disease at primary presentation. Tailored, stage-based follow up protocols allow adequate surveillance for disease activity and progression without escalating the overall costs.

Renal cell cancer in solitary kidney after donor nephrectomy.

The occurrence of renal cell carcinoma in the solitary remnant kidney after donor nephrectomy is rare and, to our knowledge, has not been previously reported. We encountered 2 such patients in whom cancer occurred 19 and 40 years after the donation. Both patients underwent successful partial nephrectomy for the tumor using two different techniques.

Squamous cell carcinoma of the renal pelvis manifesting after percutaneous nephrolithotomy for long standing calculus.

Squamous cell carcinoma of the renal pelvis is a rare neoplasm and is usually associated with long standing stone disease. The disease is aggressive in nature and usually has a poor prognosis. We report a case of renal lithiasis who underwent successful percutaneous nephrolithotomy (PCNL) for renal pelvic calculus, and eight months later presented with a large invasive squamous cell carcinoma in the same location.

Bilateral adrenal metastases from a primary hepatocellular carcinoma.

Metastatic tumors to the adrenal gland are more common than primary adrenal carcinoma. However, bilateral adrenal metastases as the first manifestation of an occult or small hepatocellular carcinoma (HCC) are very rare. An elderly male presented with transient edema of lower limbs with findings of bilateral adrenal masses and a small liver lesion on CT scan. In spite of thorough biochemical and imaging investigative modalities the final diagnosis of metastatic carcinoma could be reached only after a needle core biopsy of the lesions.

Primary primitive neuroectodermal tumor (PNET) of the kidney with venous thrombus.

Primitive neuroectodermal tumors of the kidney are rare, the diagnosis usually being made at histopathology. A young adult presented with a painful left renal mass. CT Scan of the abdomen revealed a large necrotic tumor of the left kidney. At surgery the patient was found to have a venous thrombus confined to the renal vein. Radical nephrectomy was done. Histopathology showed a round cell neoplasm with typical Homer Wright rosette formation and positive staining for neuron specific enolase (NSE) and MIC-2 on immunohistochemistry. The patient is undergoing multidrug chemotherapy and is alive and well at a follow up of nine months.

Pesticidal impact on the protein metabolism of freshwater field crab, Oziotelphusa senex senex (Fabricius).

The total protein increased in the gills and decreased in the muscle of the freshwater field crab Oziotelphusa senex senex at days 1 and 2 on exposure to lethal concentrations and at days 1 and 10 to sublethal concentrations of furadan, endosulfan, chlorpyrifos, and a mixture of these three in a 100:10:1 ratio. The increase in the gill protein was greater on exposure to the sublethal concentrations than to the lethal concentrations while the decrease in the muscle protein was greater on exposure to the lethal concentrations than to the sublethal concentrations. In the hepatopancreas, the protein content decreased on exposure to the lethal concentrations, but, in contrast, increased on exposure to the sublethal concentrations. These results clearly indicate that changes in the protein content are not only organ-dependent but also concentration-dependent, i.e., lethal versus sublethal. Irrespective of the changes in the total protein, the levels of free amino acids and the activities of protease, alanine and aspartate aminotransferases, and glutamate dehydrogenase increased in all the three organs of the crabs exposed to the lethal and sublethal concentrations, (more in lethal than in sublethal) and increased at a greater rate over time of exposure. Ammonia toxicity, measured by an increase in the hemolymph ammonia and a decrease in the urea, was also observed at the lethal concentrations of all the three pesticides. The ammonia and urea levels increased in the crabs exposed to the sublethal concentrations. Although the effect of each pesticide on the protein metabolism was similar, the degree of toxicity was the lowest on exposure to furadan, intermediate on exposure to endosulfan and chlorpyrifos, and cumulative on exposure to a mixture of the three pesticides.

Effect of sublethal concentration of mercury and zinc on the energetics of a freshwater fish Cyprinus carpio (Linnaeus).

Exposure of a freshwater fish Cyprinus carpio to the sublethal concentration of mercury (0.1 mg L-1) and zinc (6.0 mg L-1) resulted in distinct changes in the energy metabolism of gill, liver and muscle at 1, 15 and 30 days. The changes were: (a) The rate of oxygen consumption and SDH activity decreased in the organs of mercury-exposed fish at all the three exposure periods in the order 1 > 15 < 30 days. Whereas, an increase was observed in these parameters in the organs of zinc-exposed fish in the order 1 > 15 > 30 days. (b) The activity of LDH and the levels of pyruvate and lactate increased in all the three organs of the fish at the three exposure periods studied in both the metal media. But, this increase was also in the order 1 > 15 < 30 days and 1 > 15 > 30 days in the organs of the fish exposed to mercury and zinc, respectively. (c) The results indicated greater reliance of mercury exposed fish on the energetically less efficient anaerobic glycolysis as the oxidative metabolism suppressed, and the dependency of zinc-exposed fish on both the oxidative and anaerobic glycolytic pathways in order to meet the energy requirements. On prolonged exposure zinc-exposed fish could adapt to sublethal toxic stress, such type of adaptive-response was not observed in mercury-exposed fish.

Copper influenced changes of lipid metabolism in the tissues of freshwater teleost Labeo rohita (Hamilton).

Modulations in the lipid metabolism in the gill, liver, muscle and brain of freshwater teleost Labeo rohita exposed to 1, 2 and 3 days to lethal (1.2 mg/l) and 1, 15 and 30 days to sublethal (0.24 mg/l) concentrations of copper were studied. The total lipids decreased and there was an increase in the free fatty acids, glycerol and lipase activity in the organs studied at lethal concentration of copper. The degree in these shifts increased over time of exposure (1 less than 2 less than 3 days). In sublethal concentration, the levels of total lipids, free fatty acids, glycerol and lipase activity increased in all the four organs and the shifts followed two different trends during the exposure periods, 1 less than 15 less than 30 days in total lipids and 1 greater than 15 greater than 30 days in the other parameters. Among the organs, in both concentration media the changes in the lipid metabolism were in the order liver greater than gill greater than muscle greater than brain.

Comparative study on the inhibition of acetylcholinesterase activity in the freshwater fish Cyprinus carpio by mercury and zinc.

The effects of sublethal concentrations of mercury (0.1mg/l) and zinc (6 mg/l) on acetylcholinesterase activity and acetylcholine content of gill, kidney, intestine, brain, liver and muscle of the freshwater fish Cyprinus carpio at 1, 15 and 30 days of exposure were studied. A significant suppression in acetylcholinesterase activity was recorded in all the organs from both mercury and zinc intoxicated fish at all the exposure periods. Concurrently, a significant increase in the content of acetylcholine in the organs was observed. These changes observed in the organs of mercury treated fish in different exposure periods were in the order 1 greater than 15 less than 30 days and in zinc treated fish 1 greater than 15 greater than 30 days. Further, these changes were greater in magnitude in the brain, liver and muscle (non-osmoregulatory organs) than in the gill, kidney and intestine (osmoregulatory organs) in both metal media.

Effect of nickel on some aspects of protein metabolism in the gill and kidney of the freshwater fish, Cyprinus carpio L.

Nickel has an adverse effect on some aspects of protein metabolism of the freshwater fish, Cyprinus carpio. The main changes observed were: (a) Decrease in soluble, structural and total proteins, AlAT and AAT activities with an increase in the levels of free amino acids, protease and GDH activities and ammonia in the gill and kidney at 1, 2, 3, and 4 days of exposure to a lethal concentration, 40 mg litre(-1) of nickel; (b) Increase in soluble, structural and total proteins, free amino acids and the activities of protease, AlAT, AAT and GDH with a decrease in ammonia and urea in these organs at 1, 5, 10 and 15 days of exposure to sublethal concentration, 8 mg litre(-1); (c) The magnitude in these changes increased over time with both concentrations of the metal, and was more marked in gill than in kidney.

Shifts in protein metabolism in some organs of freshwater fish, Cyprinus carpio under mercury stress.

Changes in the protein metabolism of gill, kidney and intestine of freshwater fish, Cyprinus carpio exposed to 1, 15 and 30 days to sublethal concentration (0.1 mg/l) of mercury were studied. The total, soluble and structural protein contents recorded the depletion followed by progressive increase in accumulation of free aminoacids. Concurrently, the activity of protease in the tissues was also increased. A steady enhancement in the activities of aspartate aminotransferase and alanine aminotransferase paralleled the elevation of glutamate dehydrogenase activity in the organs studied. Levels of ammonia and urea have also reported elevation. All these changes clearly documented the induction of severe proteolysis. The magnitude of these changes increased overtime. These changes were more in the gill at the initial periods of exposure (1 and 15 days), but as the period of exposure increased, these changes were more pronounced in the kidney at 30 days of exposure to sublethal concentration of mercury.