Effect of a metallic balloon-expanded stent on normal rabbit ureter.

Two-millimeter balloon-expanded Gianturco-Roubin coronary artery stents were placed in the 1-mm-diameter distal ureters of five normal rabbits. Retrograde pyelograms obtained immediately after stent placement showed no obstruction or extravasation of contrast material. Follow-up excretory urograms were obtained for each animal between 4 and 17 days, and autopsy was performed between 35 and 42 days. Findings at excretory urography and autopsy demonstrated severe obstruction at the level of the stent in each animal. Histologic examination of the resected ureter was performed. In four animals, the stent had penetrated into the wall of the ureter and a fibrous reaction had obliterated the lumen. In one animal, although the stent was still present within the lumen of the ureter, a fibrous reaction within the wall had destroyed the muscle layers and narrowed the lumen at the distal end of the stent. It is concluded that the 2-mm Gianturco-Roubin stent is unsuitable for placement in the 1-mm rabbit ureter.

Intra-arterial cisplatin for bladder cancer.

Cisplatin (25 to 120 mg. per m.2) was injected into the internal iliac arteries of 33 patients with locally advanced bladder cancer. Of the patients 9 were inevaluable for response to the cisplatin, since they began radiotherapy to the bladder before course 2 of cisplatin as part of a preplanned therapeutic approach. One patient received the treatment as postoperative adjuvant therapy, 1 did not return for followup and 1 with metastatic disease did not undergo repeat cystoscopy. Of 21 evaluable patients 3 (14 per cent) achieved complete remission, 12 (57 per cent) achieved partial remission, 2 (14 per cent) were stable and 4 (19 per cent) failed. The response rate was higher in patients receiving 100 to 120 mg. per m.2 per course than in patients receiving lower doses (all except 1 of whom received 60 or less mg. per m.2 per course) (86 versus 64 per cent) and it was higher in patients without prior radiotherapy or chemotherapy. The response rate in patients with previously untreated invasive transitional cell carcinoma was 88 per cent. Of the 33 patients 21 were alive at last followup, with a median duration of followup of 32 weeks. Toxicity was dose-related and local neurotoxicity was excessive at cisplatin doses of 100 to 120 mg. per m.2. Diabetic patients were particularly prone to have neurotoxicity. Other toxicity generally was not severe and consisted of ototoxicity, nephrotoxicity, myelosuppression, nausea, vomiting and diarrhea. Even elderly patients and patients with cardiac disease tolerated the treatment well. We plan to proceed with further intra-arterial cisplatin studies in which all patients except those more than 80 years old will be treated with an intra-arterial cisplatin dose of 90 mg. per m.2 per course combined with radiotherapy with or without cystectomy.

Unusual clinical presentation of a patient with absent inferior vena cava.

We report a case of an absent inferior vena cava that presented clinically in an unusual manner. We believe this condition was caused by a combination of congenital and acquired factors. With the advent of modern imaging techniques such cases are being found with increasing frequency.

Difficulties in diagnosing and treating renal angiomyolipoma: report of three cases and review of the literature.

Renal angiomyolipoma is an uncommon benign tumor that presents diagnostic and therapeutic problems. It may be unilateral or bilateral; in its bilateral form it is usually associated with tuberous sclerosis. As a mass lesion of the kidney, it resembles renal cell carcinoma on pyelography and angiography, but computerized axial tomography and ultrasonography may provide a definitive diagnosis. This benign tumour should be treated conservatively to preserve renal function, but surgical intervention is necessary if renal cell carcinoma cannot be excluded completely.

A case of bilateral renal cell carcinoma in polycystic kidneys.

The authors present the seventh reported case of bilateral renal cell carcinoma in polycystic kidneys. They review the literature on benign and malignant tumours in polycystic kidneys emphasizing the diagnostic problems created by this condition. The diagnosis can be made by renal angiography. Therefore the authors suggest that this procedure should be carried out in all patients with polycystic renal disease who have hematuria.