Testicular venous sampling in determining the possible origin of tumour markers and its influence on management.

Testicular vein sampling is a well-known technique in the investigation of testicular function, or in determining the origin of certain plasma protein markers. We describe the application of this technique in the case of a patient who had previously undergone right radical orchidectomy for testicular teratoma, to discover the source of persistently raised tumour markers following the operation. We found this diagnostic tool useful in avoiding unnecessary procedures of the remaining testis and in guiding further treatment.

Nucleotide sequence variation in isolates of infectious salmon anaemia virus (ISAV) from Atlantic salmon Salmo salar in Scotland and Norway.

The nucleotide sequences of segments 2 and 8 of infectious salmon anaemia virus (ISAV) isolates from Scotland and Norway were determined and compared. Sequence variations were found in both segments, with segment 2 being more variable. These variations were of the same degree as those found in previous comparisons of the first recorded strain of ISAV in Scotland and Norwegian strains for which sequence information was available. The sequences again demonstrate the separation of European and Canadian strains of ISAV but, as is expected for an RNA virus, reveal that the European ISAV is not homogeneous. These results demonstrate the value of nucleotide sequences as a tool for strain identification and epidemiological investigation of ISAV.

Reducing the loss of implants following penile prosthetic surgery.

OBJECTIVE: To assess the factors associated with loss of implant following penile prosthetic surgery and to make alterations in the management of patients to prevent this from occurring. PATIENTS AND METHODS: A retrospective analysis was carried out of the factors associated with post-operative infection and erosion in 188 patients who underwent implantation of penile prostheses. A prospective study was then established in which 62 patients were managed by a set protocol designed to counteract the factors identified as being contributory to loss of implants in the retrospective review. RESULTS: In the retrospective study nine (4.8%) patients lost a prosthesis due to erosion. Erosion was noted to be more common with one type of implant which has since been modified. Infection was the cause of prosthesis loss in 12.2% of patients in the retrospective review. The new protocol resulted in a significantly reduced infection rate in penile prostheses to 1.6% (P < 0.05). CONCLUSION: With attention to simple antiseptic prophylaxis, antibiotic penetration and continuing audit, a significant improvement in the loss of penile prostheses can be achieved along with a reduction in the amount of antibiotics prescribed.

Percutaneous cholecystolithotomy: the first 60 patients.

OBJECTIVE: To assess the feasibility and possible complications of percutaneous removal of gall stones. DESIGN: Prospective study of the first 60 patients treated. SETTING: The London Clinic. PATIENTS: 60 Consecutive patients with symptomatic gall stones who agreed to have them removed percutaneously. RESULTS: 56 Patients had stones successfully removed percutaneously. In four patients failure of access necessitated a cholecystectomy under the same anaesthetic. Two patients had an empyema of the gall bladder drained initially, followed by a second operation to remove the stones one week later. Seven patients had postoperative complications, and two had recurrences of biliary calculi. CONCLUSIONS: The techniques and instruments used in percutaneous nephrolithotomy can successfully be adapted for percutaneous removal of gall stones. The procedure is suitable for a wider range of patients than other techniques that leave the gall bladder intact.

Dermatitis due to intravesical mitomycin C: a delayed-type hypersensitivity reaction?

Mitomycin C is an alkylating agent, used by intravesical instillation to treat carcinoma of the bladder. Repeated instillations can induce cystitis and an eczematous eruption affecting the palms, soles and face. If these effects are due to delayed hypersensitivity with sensitization to mitomycin C occurring in the bladder wall, it should be possible to demonstrate antigen-presenting cells in the bladder wall and positive patch tests to the drug. Using an immuno-alkaline phosphatase method we have identified CDI+ cells in bladder epithelium and submucosa and have demonstrated Birbeck granules in a few cells. In further support of our hypothesis it was also possible to demonstrate delayed type hypersensitivity in 13 out of 26 patients who had received mitomycin instillations by applying the allergen as a patch test. These results indicate that the eczematous eruption in this group of patients is most likely a hypersensitivity reaction and that it may be mediated transvesically.

Management of localised prostatic carcinoma.

Localised carcinoma of the prostate may be amenable to radical curative therapy. Staging pelvic lymphadenectomy is controversial but is the only means of demonstrating lymph node spread accurately. Five patients in a group of 16 who presented apparently with localised prostatic carcinoma, and who had negative bone scan and CT scan, were shown at operation to have metastatic carcinoma involving their lymph nodes; 3 of 8 patients with high grade tumours were free of lymph node metastases. Without staging lymphadenectomy, these patients may have been inappropriately treated.

Radiation safety during percutaneous nephrolithotomy.

Percutaneous nephrolithotomy entails a potential risk of radiation injury to the surgeon if undertaken regularly. The results of 55 consecutive cases of PCN are presented.

Percutaneous renal biopsy specimens in stone formers.

A series of renal biopsy specimens taken at the time of percutaneous nephrolithotomy were investigated for the presence and location of foci of microcalcification. Calcium was found in 18 of 25 (72%) of biopsy specimens from stone formers and in only seven of 30 (23%) of control biopsy specimens. This may indicate defective intrarenal handling of calcium as plasma calcium concentration was normal and 40% had a raised 24 hour urinary calcium excretion.

Malignant melanoma of penis.

We report a case of malignant melanoma of the penis. Appropriate staging of these rare cancers is discussed in light of current views of the biology of malignant melanoma arising at other skin sites, and the implications of Breslow thickness for management are considered. There is no good evidence in the literature that extirpation of the entire penis offers the only hope of cure for stage I penile melanoma.

Allergy to mitomycin C complicating topical administration for urothelial cancer.

Three cases are presented in which eosinophilic cystitis developed when patients who were known to have superficial bladder cancer were treated with instillations of the alkylating agent Mitomycin C.

Ureteroscopic pyelolysis for pelviureteric junction obstruction.

The development of endourological techniques for the treatment of upper urinary tract disease has concentrated mainly on the endoscopic treatment of upper urinary tract stones. The relief of pelviureteric junction obstruction (PUJ) by percutaneous pyelolysis has recently been reported and the use of the flexible uretero-pyeloscope has also been described. We describe the use of a rigid uretero-renoscopy to relieve strictures causing secondary pelviureteric junction obstruction in two cases.

Juvenile nephronophthisis and medullary cystic disease--the same disease (report of a large family with medullary cystic disease associated with gout and epilepsy).

A large family with medullary cystic disease is described to show that juvenile nephronophthisis and medullary cystic disease should not be differentiated by age of onset and type of inheritance. The age at diagnosis of six family members with medullary cystic disease ranged from 4-32 years, and age at death from renal failure or commencement of dialysis from 7-48 years. A mother of two children with renal failure in early childhood has histological evidence of medullary cystic disease with normal renal function. We suggest that juvenile nephronophthisis and medullary cystic disease are the same conditions and that the disease be classified as medullary cystic disease, autosomal dominant or recessive form. When undertaking genetic counselling in the parents of children with medullary cystic disease, we suggest that renal biopsy may need to be considered even if their renal function is normal. Three patients presented with gout, and the possibility of an association with medullary cystic disease should be considered when more than one member of a family develops gout. Two patients died of status epilepticus, and epilepsy is probably an added association of medullary cystic disease.

The pathology and pathogenesis of chronic lead nephropathy occurring in Queensland.

Many children who suffered acute lead poisoning in Queensland eventually died with contracted kidneys. In most cases the kidneys were granular and showed microscopically fibrosis, hypertensive vascular changes and "alterative glomerulitis". Clinically in these patients, hypertension and chronic renal insufficiency had always preceded death which was usually due to uraemia. In a minority of cases the kidneys showed the changes of benign hypertension but were unusually small; fibrosis and "alterative glomerulitis" were not present. Clinically these patients had had hypertension but minimal renal insufficiency and death was usually due to cerebral haemorrhage. The evidence indicates that lead caused severe damage to the kidney at the time of the lead intoxication by some mechanism other than hypertension. The sequence of events postulated comprises severe renal damage with destruction of glomeruli during childhood lead poisoning, disappearance of the destroyed tissue during childhood and adolescence, onset of hypertension in adolescence or early adult life, gradual onset and progress of chronic uraemia during which fibrosis and granularity developed. In milder cases the sequence is not complete because renal function has remained adequate.