Bilateral spermatic cord torsion in the neonate.

A case is reported of torsion of the spermatic cord in a newborn. This experience re-emphasizes the necessity of a careful and complete examination of the newborn immediately after delivery. The presence of a scrotal mass that does not transmit light represents torsion of the spermatic cord until proved otherwise, and demands immediate surgical intervention if their is to be any hope of testicular salvage. If torsion is present contralateral fixation is necessary.

Seminoma testis tumor with ipsilateral pelvic kidney.

Abdominal external beam radiation (3,000 rads) is our standard treatment for Stage A testicular seminoma. We have encountered 2 patients with localized seminomas, in each of whom excretory urography demonstrated an ipsilateral pelvic kidney. Because of significant risk of radiation nephritis and renal loss in the unshielded ectopic pelvic kideny, retroperitoneal lymphadenectomy is recommended in place of abdominal radiation.

The management of ureteral calculi during pregnancy.

During the past seven years, 14 pregnant patients were admitted to our hospital for treatment of ureteral calculus. During this same period, 22,495 deliveries were performed, for an incidence of one calculus per 1,600 pregnancies. Eleven patients spontaneously passed the calculus, ten prior to delivery and one patient postpartum. Three patients required an operation, two antepartum and one patient postpartum. No maternal or fetal complications occurred. Management of urinary calculi during pregnancy must be individualized and should be based upon location of the stone, degree of obstruction, presence or absence of infection, general condition of the patient and stage of pregnancy. Surgical intervention to remove obstructing calculi is not contraindicated during pregnancy.

Transpubic urethroplasty for membranous urethral strictures.

Six patients with traumatic membranous urethral strictures have undergone urethroplasty utilizing the traspubic approach with resection of a wedge of the symphysis pubis. Three patients are free of stricture, 2 required urethral dilatation in the early postoperative period only, and 1 patient requires dilation every three months. Four patients are completely continent of urine, 1 has mild stress incontinence, and 1 is incontinent because of a neurogenic bladder. This approach provides excellent exposure with minimal morbidity and allows an easy under-vision anastomosis.

Recurrent urothelial tumors following surgery for transitional cell carcinoma of the upper urinary tract.

A retrospective analysis of 74 cases of transitional cell carcinoma of the renal pelvis and ureter treated at this institution over the past 30 years is presented. When nephrectomy alone or incomplete nephroureterectomy was performed, subsequent transitional cell carcinoma developed in 30% of the ureteral stumps. Subsequent bladder carcinoma occurred in 25% of the patients with primary upper urinary tract carcinoma. The type of initial surgery performed did not appear to influence this incidence of subsequent bladder tumors. Contralateral upper urinary tract carcinoma developed in only one patient. When nephroureterectomy is performed for carcinoma of the renal pelvis and ureter, a cuff of bladder that includes the ureteral orifice should be removed to obviate recurrent disease in the ureteral stump. Since single-incision nephroureterectomy did not include the intramural ureter in 50% of the cases in which it was performed, a second incision may be required for adequate exposure.

The ureteral stump after nephroureterectomy.

Herein we review 70 cases of transitional cell carcinoma of the upper urinary tract. When complete nephroureterectomy was not performed transitional cell carcinoma developed in 30 per cent of the remaining ureteral stumps. Single incision nephroureterectomy did not include the intramural ureter in 50 per cent of the cases in which it was performed. When nephroureterectomy is selected as treatment for carcinoma of the renal pelvis or ureter a cuff of bladder, which includes the ureteral orifice, should be removed. A second incision may be required for adequate exposure.

Disseminated nocardiosis presenting as testicular abscess.

A case of a localized testicular abscess due to Nocardia asteroides in a patient on immunosuppressive therapy for a myeloproliferative disorder is reported. Subsequent fatal dissemination of the infection to the prostate, lungs, and liver occurred. This represents the second reported case of nocardiosis of the testis. Extrapulmonary forms of nocardiosis must be recognized so that appropriate treatment can be instituted prior to dissemination.

Abnormalities of renal perfusion and the renal pressor system in dogs with chronic aortic coarctation.

To clarify the role of the renin-angiotensin system in coarctation hypertension, 2-year-old inbred dogs with chronic neonatally induced thoracic aortic coarctation were subjected to 6 days of rigorous salt restriction. The following parameters were then measured: glomerular filtration rate, renal plasma flow, plasma renin activity, plasma renin concentration, renin reactivity, and renin substrate concentration. Glomerular filtration rate and renal plasma flow were significantly lower in salt-restricted coarcted dogs: 3.0 +/- 0.2 and 9.0 +/- 1.5 ml/min kg-1, respectively, compared with values of 4.0 +/- 0.2 (P less than 0.005) and 13.2 +/- 0.6 (P less than 0.025) ml/min kg-1 in salt-restricted controls. Plasma renin activity was abnormally high in experimental dogs: 13.5 +/- 2.5 vs. 4.5 +/- 1.5 ng angiotensin I/ml hour-1 in controls (P less than 0.005). In addition, a significant elevation of renin reactivity (indicating a relative increase in circulating accelerators or a relative decrease in inhibitors of the renin reaction) was apparent in the plasma of coarcted dogs. Plasma renin concentration was elevated but to an insignificant degree in coarcted dogs, and renin substrate concentration was comparable with that of controls. The impaired renal perfusion and abnormal elevation of plasma renin activity during salt restriction is analogous to clinical and experimental observations in hypertensive states associated with total renal underperfusion and supports a major role for the renal pressor system in the pathogenesis of coarctation hypertension. The insignificant elevation of plasma renin concentration is not incompatible with this view. The demonstration of increased renin reactivity in coarctation hypertension provides additional evidence that acceleration of the renin reaction is common to all hypertensive states.