A clinical comparison of cinoxacin and nalidixic acid in the treatment of urinary tract infection.

In a single blind clinical study of 50 patients with urinary tract infections 250 mg. cinoxacin were compared to 1 g. nalidixic acid 4 times daily. Both drugs produced similar improvement in symptomatic response during therapy and were equally effective in eradicating the causative pathogens. In the 5 of 9-day post-therapy followup 4 patients from the cinoxacin group became reinfected compared to 1 from the nalidixic acid group. Side effects were reported by twice as many patients in the nalidixic acid group. It is concluded that cinoxacin is an effective drug for the treatment of uncomplicated urinary tract infections.

Transitional cell carcinoma of the kidney 25-year experience.

Seventy patients with transitional cell carcinoma of the kidney operated upon at Barnes Hospital during the last 25 years are reviewed. The relationship of the pathologic stage, grade, findings on excretory urography and survival is studied. The stage and survival rates were predicted fairly accurately on the basis of the excretory urogram alone. Survival of patients was determined occasionally by the status of the associated bladder tumors more than by the renal cancer. Because of tumor multiplicity we recommend total nephroureterectomy as the treatment of choice. The role of radiation therapy is considered.

Malacoplakia of the prostate.

Malacoplakia is a granulomatous disease of unknown cause often associated with a coliform urinary infection. It is occasionally a self-limiting disease with diverse clinical presentations and roentgenographic appearances. The importance of a differential diagnosis which considers malignancy is emphasized. A rare instance of malacoplakia involving prostatic tissue is reported.

Intravenous hyperalimentation in the treatment of difficult urologic problems.

Intravenous hyperalimentation has gained great acceptance in the management of complex medical and surgical problems. This paper presents two cases of fistula developing in patients treated with irradiation and who had total cystectomy and ileal conduit diversion for carcinoma of the urinary bladder. The fistulas closed completely after two to four weeks of hyperalimentation. Neither patient required operation. Parenteral nutrition can be of value in the management of various difficult urologic problems.

Acetazolamide-induced renal calculi.

The occurrence of urinary calculi associated with acetazolamide therapy is described. Patients with a history of urinary stones or surgery are a significant risk for further calculus formation when treated with acetazolamide. The concurrent use of sodium bicarbonate further potentiates this risk.

Manipulation of torsion of the testicle.

Testicular torsion, although not an uncommon clinical entity, is likely to be unrecognized, particularly if the patient is not within the expected age range. Manual derotation can readily be achieved and will significantly improve results of ultimate treatment. All painful scrotal masses should be considered possible torsed testes, unless obvious predisposing factors exclude its diagnosis.

The silent neurogenic bladder.

Children with occult or silent neurogenic bladders may present with urinary reflux and severe upper urinary tract deterioration. Commonly, the neuro-deficit eludes detection. Reimplantation of these ureteral units will likely result in failure.

Spontaneous pyeloduodenal and renocolic fistulas.

Twenty-seven previously reported cases of pyeloduodenal fistulas are reviewed and the first case of a simultaneously occurring pyeloduodenal and renocolic fistula is reported. Pyeloduodenal fistulas appear to result from an inflammatory process originating in the kidney, frequently are associated with calculi, and are best managed surgically with nephrectomy and closure of the fistula.

Choriocarcinoma and bilateral renal metastases.

A case of choriocarcinoma presenting with metastases to both kidneys is reported. The epidemiologic and pathologic aspects of gestational choriocarcinoma are briefly discussed. Prior reports of renal metastases with choriocarcinoma are reviewed, and the fairly typical clinical presentation for this entity is emphasized.

An XX male: cytogenetic and endocrine studies.

A 3 year old black male with ambiguous genitalia had a 46, XY karyotype in a bone marrow culture and an intermediate buccal smear result, suggestive of a mosaic of chromatin positive and chromatin negative cells. Upon re-evaluation at age 15 years, he has a 30% positive buccal smear and a 46, XX karyotype in cultures of peripheral blood lymphocytes, skin fibroblasts, bone marrow, and testis. No Y-body fluorescence was detectable in interphase cells from the testicular biopsy or the various cultures. The testicular biopsy appeared similar to that of XXY males, and primary hypogonadism was documented by elevated LH (107 mIU/ml) and FSH (57 mIU/ml) levels in conjunction with low testosterone (142 ng/100 ml). Administration of hCG produced qualitatively normal acute responses of testosterone and estrogens. The cytogenetic data provide support for the theory that at least some XX males once had a Y-containing cell line which was subsequently lost.