Metachronous renal cell carcinoma metastasis to the contralateral adrenal gland.

OBJECTIVES: Metachronous metastasis of renal cell carcinoma to the contralateral adrenal gland is very rare. We review our experience with 5 such patients and compare it with reports in the literature. METHODS: The records of all 350 patients who underwent nephrectomy for renal cell carcinoma in our center between 1975 and 1992 were reviewed. Five patients were found to have had solitary metachronous metastases to the contralateral adrenal gland on follow-up. RESULTS: The adrenal metastasis was discovered 18 to 210 months (mean 66.8) after nephrectomy. In 2 patients the lesion was found incidentally on routine computed tomography scan; in the other 3 patients, diagnosis was by ultrasonography, performed because of flank pain and weight loss or routine follow-up. All patients underwent adrenalectomy. Survival ranged from 8 to 64 months (mean 36.4); 3 patients had no evidence of disease at 42, 44, and 64 months postoperatively, and 2 patients died of pulmonary metastasis at 8 and 24 months. Analysis of the clinical data of our 5 patients together with the 9 we found in the published reports revealed that the mean interval between nephrectomy and the appearance of adrenal metastasis was shorter in the patients who died. CONCLUSIONS: The results of adrenalectomy for metachronous metastasis of renal cell carcinoma to the contralateral adrenal gland are unpredictable. The prognosis is somewhat better when the mean interval between the nephrectomy and the appearance of the adrenal metastasis is longer than 18 months. We recommend adrenalectomy because long-term survival is expected in some of these patients.

A randomized trial of the efficacy and acceptability of a pen injector.

A controlled trial of pen injection of insulin was performed in 78 patients, with assessment of metabolic control and lifestyle. After a 6-week run-in period, during which control was optimized, the patients were randomized, either to stay on a twice daily insulin regimen (n = 37), or to change to a three times daily pen regimen with human ultralente at night (n = 41). Over the 20 weeks, there was no significant change in mean glycosylated haemoglobin (syringe, mean +/- SD, 11.1 +/- 2.5% to 10.9 +/- 2.0%; pen, 11.3 +/- 2.6% to 11.2 +/- 2.0%), in blood glucose profiles or in frequency of hypoglycaemic attacks in either group. A self-completed questionnaire demonstrated high patient satisfaction with the pen injector (NovoPen), 78% for effect on lifestyle and 81% for increased flexibility. Ninety-five percent preferred the pen injector regimen to conventional treatment and stayed on it.

Light and electron microscopic studies on various developmental stages of Hoferellus cyprini (Doflein, 1898).

The development of Hoferellus cyprini (Myxosporea) in common carp was studied by light and electron microscopy. It has been established that in the autumn the early developmental stages are located in a cell syncytium formed from the epithelium of the renal tubules. The authors share the opinion of Lom and Dyková [13] that each intracellular trophozoite corresponds to a primary parasitic cell which contains secondary, tertiary and quaternary cells having formed by internal cleavage. From December the trophozoites are released into the tubular lumen, and the secondary cells are transformed into coelozoic plasmodia. Spores are formed inside the Plasmodia in the ureter or renal tubules in April. The sporoblast cells correspond to the quaternary cells of the trophozoites. On the surface of each of the two spore valves 10 striations run longitudionally and continue in bristles at the caudal end of the spores. Morphologically, the spores are consistent with the description of Mitraspora cyprini Fujita, 1912. Therefore, the authors regard M. cyprini as a synonym of Hoferellus cyprini (Doflein, 1898).