Ipsilateral ureteroureterostomy for single ureteral reflux or obstruction in a duplicate system.

PURPOSE: The traditional treatment for obstruction or reflux involving a single ureter in a duplicated system has been common sheath reimplantation. More recently, ipsilateral ureteroureterostomy has been suggested as an alternative treatment. We reviewed cases with duplicate systems that were treated with ipsilateral ureteroureterostomy at our institution to determine the acceptability of this operation as an alternative to common sheath reimplantation. MATERIALS AND METHODS: A total of 22 patients with 24 duplicate systems underwent ipsilateral ureteroureterostomy between March 1986 and December 1996. Patient charts were reviewed and analyzed for patient age, sex, ureteral and renal anatomy, initial presentation, the clinical situation necessitating operation, and the occurrence of early and late complications. Patients were followed for a mean period of 41.4 months. RESULTS: Two adults and 20 children 10 years old or younger presented with urinary tract infection (13), hydronephrosis on maternal ultrasound (5), dribbling (2), ureteral calculus (1) and hydronephrosis on neonatal abdominal ultrasound (1). Mean hospital stay was 3 days. There was 1 early and 1 late complication. CONCLUSIONS: Ipsilateral ureteroureterostomy is an acceptable alternative to common sheath reimplantation in select patients with single ureteral disease in a duplicate system.

GM-CSF secretion in primary cultures of normal and cancerous human renal cells.

Rates of secretion of granulocyte-macrophage colony stimulating factor (GM-CSF) were measured in 50 primary cell cultures derived from cancerous and normal human kidneys. Mean rates of GM-CSF secretion measured by TF-1 cell proliferation assay (N = 21) and by ELISA (N = 31) were 2.5 and 7.8 ng/10(6) cells/24 hr, respectively. There was no significant difference between the mean rates of GM-CSF secretion by cancerous and normal renal cells. GM-CSF was also secreted by primary renal cell cultures grown in serum-free medium and by renal cell lines. GM-CSF mRNA was detected by RT-PCR in cultured renal cells, but not in undissociated kidney tissue. Rates of GM-CSF secretion were reduced up to 99% under conditions where the cellular density or substratum more closely resembled the in vivo environment. Some cultured human renal carcinoma cells (RCC) secreted GM-CSF at levels that occasionally overlapped the levels produced by the GM-CSF gene-modified human RCC vaccine now in phase I trial. The data indicate that GM-CSF is not expressed in vivo, and that stable GM-CSF secretion is induced by the dissociation and culture of human renal cells.

Excisional plication of the ileocecal valve: a useful adjunct for the construction of continent urinary diversions.

PURPOSE: A variety of techniques exist to reinforce the ileocecal valve for use as a nonrefluxing mechanism in continent urinary diversion. We report short-term and long-term followup for a new technique of excisional plication of the valve. MATERIALS AND METHODS: Since 1988 we performed 16 procedures in 15 patients. The technique was used for repair of an incompetent ileocecal valve to restore continence in 2 patients in whom continent cutaneous diversion failed, and to correct a massively refluxing ileocecal valve following previous augmentation with an ileocecal segment in 1. The remaining patients underwent the procedure in conjunction with continent cutaneous ileocecal diversion with a modified Indiana pouch. RESULTS: To date no patient undergoing continent cutaneous diversion required reoperation to correct incontinence. Two patients wear a protective pad during the day, while the remainder have been completely dry during followup. CONCLUSIONS: Excisional plication is a versatile and simple procedure that may be used to assist construction and repair of ileocecal valves in conjunction with continent urinary diversion.

Intrapulmonary lymph nodes masquerading as renal cell carcinoma metastases.

Clinically apparent intrapulmonary lymph nodes are rare but may be incorrectly diagnosed as pulmonary metastatic disease. We report on a 65-year-old man who presented with a left renal mass and left lower lobe pulmonary nodules that were interpreted radiographically to be consistent with metastatic disease. Surgical pathologic examination confirmed intrapulmonary lymph nodes and a Stage II renal cell carcinoma. Failure to diagnose intrapulmonary lymph nodes may result in erroneous diagnosis of metastatic disease and preclude potentially curative treatment.

Cystic renal cell carcinoma and acquired renal cystic disease associated with consumption of chaparral tea: a case report.

Nordihydroguaiaretic acid is an antioxidant used experimentally to induce cystic renal disease in rats. It may be extracted from the leaves of the creosote bush, which are consumed as chaparral tea in the southwestern United States. We report a case of cystic renal disease and cystic adenocarcinoma of the kidney associated with a history of protracted consumption of chaparral tea.

Crossed fused renal ectopy in children with myelodysplasia.

The medical records of 151 patients with myelodysplasia ranging in age from 3 months to 22 years were reviewed to determine the incidence of crossed fused renal ectopy. Five patients (3.3%) were identified. This figure is considerably higher than the reported incidence of 1:200 (0.5%) to 1:7500 (0.013%) in the general population.

Hormonal therapy for stage D cancer of the prostate.

Adenocarcinoma of the prostate is the most common malignant neoplasm occurring in men. About half of patients present with metastatic disease. The mainstay of the treatment of stage D cancer of the prostate is hormonal therapy. Bilateral simple orchiectomy remains the gold standard with which other therapies must be compared. Luteinizing hormone-releasing hormone analogues and antiandrogens are now most commonly used but are costly. Initiating hormonal therapy immediately on diagnosing metastatic disease appears to have some advantage over delaying therapy until a patient is symptomatic. Total androgen blockade also appears to be beneficial in terms of survival but at high cost.

Signet ring cell adenocarcinoma of prostate.

Primary signet ring cell adenocarcinoma of the prostate is a rare malignancy with a total of 13 cases reported to date in the English literature. We report a very unusual case of signet ring adenocarcinoma of the prostate occurring in a patient who presented initially with irritative voiding symptoms and a bladder mass. Results of immunohistochemical, flow cytometric, and cytogenetic analyses of the tumor are presented.

Phase II evaluation of merbarone in renal cell carcinoma.

The Southwest Oncology Group (SWOG) studied the response rate and toxicity of merbarone (1,000 mg/m2 IV continuous infusion days 1-5, q 21 days) in patients with advanced metastatic renal cell carcinoma. Among 36 eligible patients, there was one partial response for a response rate of 3% (95% C.I. 0.1-15%). There were no mixed responses. There were no treatment related deaths or adverse drug reactions. Significant anemia, diarrhea, and hypercalcemia were observed. Mild to moderate degrees of malaise/fatigue/lethargy, dizziness/vertigo, hyperglycemia, creatinine increase, nausea, vomiting, weight loss, pedal edema, dyspnea, and granulocytopenia were noted. Merbarone does not have significant activity as a single agent in advanced renal cell carcinoma.

Treatment of stages B3 and C seminoma with chemotherapy followed by irradiation therapy. Southwest Oncology Group Study.

Beginning in 1981, 28 patients with advanced seminoma were treated with combination chemotherapy followed by irradiation to evaluate the possibility of improved survival using both modalities. The treatment protocol consisted of two courses of vincristine, actinomycin-D, and cyclophosphamide followed by reassessment. Those initially presenting with Stage B3 disease who achieved a complete response to two cycles of chemotherapy then underwent irradiation. All others were given a third course of chemotherapy before undergoing irradiation. The pre-radiation portion of this protocol produced a complete response rate of only 25 percent, substantially less than other, more recent, protocols. Radiation therapy produced a complete response in 69 percent of those who did not achieve a complete response from chemotherapy, increasing the complete response rate from 25 percent to 64 percent. Given this response rate to radiation therapy and the difficulty of dissection and associated morbidity with the surgical excision of postchemotherapy residual masses, the best option at this time may be observation with salvage chemotherapy and/or radiation reserved for those with disease progression.

Ureteral obstruction and hydronephrosis as a complication of lymphomatoid granulomatosis: a case report and literature review.

Lymphomatoid granulomatosis is an angioinvasive proliferation of atypical T lymphocytes, with frequent pulmonary, cutaneous and neurological manifestations. Urological complications are infrequent. We describe the case of a 40-year-old man who presented with typical intrathoracic findings of lymphomatoid granulomatosis. Following a chemotherapy-induced remission he had retroperitoneal recurrence with bilateral ureteral obstruction, hydronephrosis and renal insufficiency. Histological examination revealed, in addition to the characteristic lymphoid infiltrates of lymphomatoid granulomatosis, a sclerosing process similar to idiopathic retroperitoneal fibrosis.

Aggressive angiomyxoma of the female pelvis and perineum: review of the literature.

Aggressive angiomyxoma is an uncommon neoplasm which predominantly involves the pelvis and perineum of young White females. Misdiagnosis is common. Treatment typically involves surgery, and in spite of apparently complete resection, recurrences are common. Local spread into the adjacent fascia and musculature is frequently reported, and rarely, extension into intestine and bladder. The first reported case of pubic bone involvement, including its histology, radiologic features, and operative management, is discussed. Including this patient, 26 women with this tumor have been reported in the literature and are reviewed, along with 2 previously reported cases from the University of New Mexico Tumor Registry.

Individual variability in self-reported improvement for depressed psychiatric inpatients on the MCMI-II.

This study evaluated self-reported symptom improvement on the MCM-II Dysthymia (D) scale for 109 depressed psychiatric inpatients. Rather than presenting the findings in traditional "group mean" format, data were analyzed to highlight the variability of clinical improvement for individual patients. Two criteria for judging clinically significant improvement (Jacobson, Follette, & Revenstorf, 1984) were employed, namely, that the client move from the dysfunctional to functional range during treatment and that the change between pretest and posttest be statistically reliable. Results indicated that 39 (35.8%) of the 109 patients met these criteria.

Combined versus sequential chemo-endocrine therapy in advanced prostate cancer: final results of a randomized Southwest Oncology Group study.

Cytotoxic chemotherapy has not provided survival benefit in metastatic prostate cancer, although it has been used most frequently in patients with far-advanced, refractory disease. To evaluate the effects of chemotherapy given earlier in the course of the disease, the Southwest Oncology Group (SWOG) performed a randomized trial between September 1982 and October 1986 comparing endocrine therapy (diethylstilbestrol [DES] or orchiectomy) alone followed by cyclophosphamide-Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH) chemotherapy at progression versus initial combined chemo-endocrine therapy. One hundred forty-three patients were registered, and only six were declared ineligible. Patients on the combined chemo-endocrine therapy arm had a slightly higher response rate (63%) compared with endocrine therapy alone (48%). A log-linear model of tumor response and treatment arm adjusted for the stratification factors favored the combination arm (P = .059). Only three of 27 patients on the endocrine therapy alone arm had an objective partial response when crossed over to chemotherapy, while two others had stable disease. Despite the difference in initial response rate, time to treatment failure and survival were identical in the two treatment arms. Seventy-seven percent of patients on the initial endocrine therapy alone arm have died (median survival, 25.6 months) compared with 78% on the chemo-endocrine therapy arm (median survival, 22.0 months). No significant effect of treatment on survival was observed even after adjustment for the stratification variables in a Cox regression model. Exploratory survival analyses with patients on both arms combined did show a marginally significant time to treatment failure and survival advantage for patients treated with DES rather than orchiectomy as initial endocrine therapy. Eighty-six percent of patients treated by orchiectomy have died compared with only 65% of those treated with DES. These data do not support the addition of cytotoxic chemotherapy to initial endocrine therapy in patients with metastatic prostate cancer.