Paraganglionic phaeochromocytoma presenting twelve years after adrenalectomy.

We present a case report of recurrent hypertension in a 43-year-old man 12 years after undergoing right adrenalectomy for phaeochromocytoma. Further investigations showed a tumour arising from the right paravertebral chain and raised urinary noradrenaline levels. Histological examination after surgical excision found the tumour to be a paraganglionic phaeochromocytoma.

Target organ disposition and plasma pharmacokinetics of doxorubicin incorporated into albumin microspheres after intrarenal arterial administration.

We synthesized doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH)-loaded human albumin microspheres (containing approximately 1% doxorubicin w/w) between 15 and 20 micron in diameter. Intrarenal arterial administration of 99mTC-labeled microspheres demonstrated a high renal entrapment ratio (97% of recovered radioactivity). The pharmacokinetics and metabolism of doxorubicin are different when it is administered in microspherical form. Peak plasma levels are lower (16 ng/ml versus 135 ng/ml) compared with treatment by a doxorubicin solution. Histologic studies showed that the microspheres were trapped within capillaries and small arterioles in the renal vascular arcade. It is apparent that chemoembolization with doxorubicin-loaded microspheres significantly reduces systemic exposure to the antineoplastic agent, and maintains intrarenal drug levels.

Occult primary seminoma: eighteen-year delay in presentation.

Primary retroperitoneal seminoma is well documented. A case is reported in which a patient presented with a seminoma of testis eighteen years after removal of a retroperitoneal seminoma. Histologic appearance of the testis was identified to the original pathology, and it is proposed that this represents recurrence of an occult testicular seminoma.

Fused vesical calculi.

A case is described in which a patient, who initially presented with five separate bladder calculi, was found to have had coalescence of three calculi to produce a large stone. This may be one mechanism in the development of a giant vesical calculus.

The radiology of sarcomas and sarcomatoid carcinomas of the kidney.

Tumours of the kidney with sarcomatoid elements are uncommon. The radiological findings in 11 patients with such lesions are presented. It is important to separate pure sarcomas from lesions with sarcomatous and carcinomatous elements since they have different radiological appearances and prognosis. These tumours often show calcification on radiographs and on angiography appear predominantly avascular with a blood supply from capsular vessels. Because of their rarity and the overlap of radiographic findings with more common tumours the diagnosis cannot be made by current imaging methods alone.

Collecting duct carcinoma of the kidney.

Six cases of renal epithelial neoplasms, which show atypical histological features previously described in cases of collecting duct carcinomas, are presented. The tumours were of a tubulo-papillary architecture, arose in the renal medulla and showed prominent infiltrating tubules with an associated desmoplastic reaction. Atypical hyperplastic changes were present in the medullary collecting ducts in five cases.

Calculocutaneous sinus.

Extrusion of a urinary calculus is a rare occurrence, and to date only 7 cases have been previously documented. Three patients are described, all of whom had a persistent discharging calculocutaneous sinus as a manifestation of the extruded calculus. The 3 cases had similar features of presentation with a perinephric abscess, a staghorn calculus within a nonfunctioning kidney, and a classic radiologic feature of a portion of calculus clearly distinct from the main bulk of the stone.

Renal oncocytoma.

Oncocytic renal tumour is an uncommon tumour of the kidney, previously associated with a good outcome. Twenty-two patients are described in whom the incidence of metastatic disease was 18% and the overall 5-year survival rate 65%.

Urinary tract lymphoma.

Urinary tract involvement by non-Hodgkin's lymphoma is uncommon and whilst extranodal disease may be the first manifestation of NHL in 15% of patients, the primary site of origin of NHL in the urinary tract is very rare. At the time of diagnosis, apparently primary urogenital lymphoma is often widely disseminated, with a correspondingly poor prognosis.

Bacterial culture of the anterior urethra and its relationship to post-operative bacteriuria.

The role of the anterior urethral culture and its relationship to post-operative urine infection in patients undergoing transurethral surgery was studied in 43 consecutive patients. A significant relationship between the anterior urethral culture and subsequent urine infection in patients with a sterile pre-operative urine was noted (p less than 0.01).

Bacteriological study of renal calculi.

The pre-operative urine, pelvic urine, removed calculi and calculus washings were examined bacteriologically in 24 patients undergoing removal of intrarenal calculi. Four of seven patients with struvite calculi had an infected pre-operative midstream urine specimen and six of the seven removed calculi demonstrated significant bacterial growth. Proteus mirabilis was the commonest organism isolated. Of 17 patients with oxalate calculi only one had an infected pre-operative urine culture, but in four cases the removed stones were infected. Quantitative bacteriological culture of the stones and their washings demonstrated that infection is within the stone itself. Pre-operative urine culture failed to predict infection within the stone in 60% of patients with infected stones. The results suggest that the presence of infected urine together with the presence of renal calculus is indication for removal of the calculus.

Malignant phaeochromocytoma.

Malignant phaeochromocytoma is a rare tumour and experience in its management is therefore limited. Five patients are discussed in whom the development of metastases was associated with rapidly progressive disease.

Survey of antibiotic prophylaxis in British urological practice.

Guidelines for the use of prophylactic antibiotics to cover operative procedures on the urinary tract have been suggested, but the extent to which these have been adopted into routine practice has not been assessed. This survey documents the use of prophylactic antibiotics in urological surgery in Britain. It demonstrates that awareness of the potential role of antibiotic prophylaxis is increasing. Most urologists now adopt a selective approach in the use of prophylactic agents.

Fournier's gangrene and urethral problems.

Fournier's classical description of infective genital gangrene has been frequently amplified. We present seven patients in whom the exact site of gangrene was related to the origin of the infection, either from the urethra or from the anorectum. A sixth case of diabetes presenting as Fournier's gangrene is described. The need for urological assessment in this condition is discussed.