[Paratesticular sarcomas. Case report of leiomyosarcoma]. / Paratesticuläre Sarkome. Fallbeschreibung eines Leiomyosarkoms.

Paratesticular sarcomas are rare. We discuss this entity with the aid of a case report and the existing literature. The therapy of these tumors includes resection and possible adjuvant radiotherapy. Rhabdomyosarcomas are an exception, because they also show a good response to chemotherapy.

Intravesical versus intravesical plus intradermal bacillus Calmette-Guerin: a prospective randomized study in patients with recurrent superficial bladder tumors.

PURPOSE: Intravesical instillation of bacillus Calmette-Guerin (BCG) induces various immunological reactions and decreases the recurrence rate of superficial bladder tumors. To determine whether additional immune stimulation with concomitant intradermal BCG applications could further lower the recurrence rate, 154 patients with superficial bladder tumors at high risk for recurrence were randomized to receive either 6 intravesical instillations of 120 mg. Pasteur strain BCG alone or combined with intradermal application. MATERIALS AND METHODS: A total of 76 patients received intravesical and intradermal BCG, while 78 received intravesical BCG only. Median followup was 41 months (range 2 to 89) and 36 months (range 2 to 86), respectively. Both treatment groups were comparable regarding patient age and number of previous transurethral bladder tumor resections, as well as tumor recurrence rate, stage and grade before BCG therapy. RESULTS: A highly significant decrease in the monthly tumor recurrence rate was observed in both arms after BCG compared to the pretreatment recurrence rates (p < 0.0001). Recurrence rate decreased from 0.73 +/- 1.07 (standard deviation) to 0.06 +/- 0.13 in the combined treatment group and from 0.71 +/- 0.90 to 0.074 +/- 0.17 in the intravesical treatment only group. However, we were unable to find any difference between the 2 groups regarding interval to initial recurrence or recurrence rates after BCG treatment. Changes in the purified protein derivative skin test performed before and after BCG therapy were not useful to predict response to treatment because 44% of our patients already had a positive test before treatment. Also, interpretation of the skin test was difficult and not always reliable. In the multivariate analysis, however, fever was an important prognostic factor. Patients with increased body temperature greater than 37.5C had a significantly lower recurrence rate than those without fever (37.5C or less) after BCG instillation (p = 0.009). Moreover, fever after BCG instillation was observed significantly more frequently in patients with a positive purified protein derivative skin test before treatment (p = 0.021). CONCLUSIONS: The therapeutic benefit from intravesical BCG apparently was not substantially improved by simultaneous intradermal BCG vaccination. Fever following intravesical BCG instillation is an important prognostic factor regarding superficial bladder tumor recurrence. Fever occurs predominantly in patients who were previously sensitized to mycobacteria (by BCG vaccination or infection) as shown by a positive pretreatment purified protein derivative skin test. This finding suggests that previously sensitized patients respond significantly better to a single course of intravesical BCG.

Influence of calcium content in mineral water on chemistry and crystallization conditions in urine of calcium stone formers.

19 idiopathic recurrent calcium stone formers were examined on a constant diet supplemented with mineral water of high (386 mg/l) and low (10 mg/l) calcium content. The effects of calcium and oxalate loading were studied separately. Ingestion of mineral water with high calcium content lead to an increase of urinary calcium and a decrease of urinary oxalate compared to mineral water with low calcium content. On the calcium-rich mineral water, urinary saturation with Whewellite was lower and it hardly reached the critical level for calcium oxalate crystallization after oxalate loading, which was in contrast to the results on low calcium mineral water. Urinary Brushite saturation was generally low and showed no significant differences between the two mineral waters.

Renal handling of norepinephrine and epinephrine in the pig.

To investigate the renal handling of catecholamines in the pig, intravenous infusions of 51Cr-EDTA and PAH were performed in 7 animals, and samples for simultaneous measurement of norepinephrine (NE), epinephrine (E), 51Cr-EDTA and PAH were obtained through catheters placed into the aorta, left renal vein and both urethers. For both kidneys together, 51Cr-EDTA clearance [GFR] averaged 48 +/- 14 (+/- SD) ml/min (2.23 +/- 0.66 ml/kg/min). In the left kidney, GFR averaged 22 +/- 9 ml/min, arteriovenous PAH extraction 0.87 +/- 0.09, and calculated total renal plasma flow 91 +/- 30 ml/min. Plasma NE and E were lower in renal venous than arterial blood (P less than 0.005), extraction ratios averaging 0.36 and 0.77, respectively. NE excretion rate in final urine (8.9 +/- 4.3 ng/min) exceeded transrenal NE extraction rate (5.2 +/- 3.9 ng/min) by 3.7 +/- 4.4 ng/min. In contrast, urinary E excretion rate (2.9 +/- 2.0 ng/min) was slightly lower than transrenal E extraction rate (3.6 +/- 3.8 ng/min). These observations suggest that in pig kidneys, plasma PAH extraction rate and GFR related to body weight are quite similar to values in man. Three quarters of circulating E are extracted for the most part by tubular secretion, and the slightly smaller amount appearing in urine is consistent with some intrarenal metabolism. NE, presumably originating from intrarenal neuronal release and/or de novo production, is secreted into the urine.

Experimental acute renal artery stenosis. Dynamic CT and renal perfusion.

Unilateral renal artery stenosis of varying degrees was induced in six of seven pigs. Renal perfusion prior to and after stenosing the renal artery was determined by standard renal clearance and by the direct measurement of renal blood flow. Renal blood flow was reduced from 29 to 56% (mean 40%) in the poststenotic ischemic kidneys. A significant correlation was found between the opacification of the poststenotic ischemic kidneys after intraaortic bolus injection and direct renal blood flow (r = 0.89, P less than 0.01). There was also a significant correlation (r = 0.85, P less than 0.01) between the opacification of the kidneys and their respective glomerular filtration rates. Renal opacification determined by CT correlates significantly with renal perfusion.

[Operative treatment of fractures of the penis (author's transl)]. / Operative Behandlung der Penisfraktur.

5 cases of penile fracture are described. 2 patients were referred directly and received immediate surgical treatment. The corpus cavernosum was exposed and the tunica albuginea repaired with absorbable sutures. The other 3 patients were referred from 10 to 19 days after the initial injury. On admission 2 of the were experiencing deviation of the erect penis, one also had painful erection. They too were explored and the tunica albuginea sutured to correct the deformity. All 5 patients were treated post-operatively with a broadspectrum antibiotic, an anti-inflammatory agent and tranquilizers to prevent erections. Except for one patient with delayed wound healing there were no complications of the operation. The long-term results were good, all patients experiencing satisfactory straight erections.

[Accidental rupture of the renal vein in radical tumor nephrectomy of a local bleeding hypernephroid carcinoma. Case report]. / Akzidentelle Durchtrennung der Vena renalis bei radikaler Tumornephrektomie eines lokal blutenden hypernephroiden Karzinomas.--Fallbericht.

This case-report aims to stress the increased difficulty of operating on a locally widespread hypernephroma in presence of a complicating haemorrhage. It also shows an easy method of managing a rare intraoperative vascular complication.

Nephroscopy in stone surgery.

We present the results of our experience with the use of the nephroscope in 130 open procedures for removal of renal stones. The Storz rigid instrument was used and permitted visualisation of approximately 60% of calices and frequent identification of small stone fragments which would not otherwise have been seen. In 32 patients biopsies were taken on papillary epithelium. In 8, plaques of subepithelial calcification were identified. These were macroscopically obvious and widely distributed over the caliceal epithelium. A high proportion of the biopsies (66%) showed a chronic inflammatory cellular infiltrate which was not necessarily related to urinary infection. Such generalised changes again indicate the futility of partial resection in the management of renal stone disease.

[Drainage following urological surgery]. / Drainage nach urologischen Eingriffen.

Prolonged leakage of urine and infection are the most troublesome complications following surgical exposure of the lumen of the urinary tract. The available methods of wound and urinary drainage are discussed. Careful attention should be paid to the material from which the drain is manufactured, because of long periods of drainage in a closed system.