Vesicouterine fistula twenty years following brachytherapy for cervical cancer.

This report concerns an extremely rare type of fistula, a vesicouterine fistula, in a 59-year-old female occurring twenty years following brachytherapy for cervical cancer. The patient presented with a history of recurrent urinary tract infections, sensation of incompletely emptying the bladder, nocturia and constant leakage of urine for several months. Cystoscopy revealed a fistulous opening and an exophytic lesion on the posterior bladder wall. Contrast computerized tomography demonstrated a fistulous tract between the posterior bladder wall and the anterior aspect of the uterine cavity. She underwent a hysterectomy, excision of the bladder fistula and interposition of a vascularized rectus muscle graft. Histology of the cervix and bladder only revealed inflammatory changes with no evidence of malignancy. The diagnosis and investigation of this extremely rare condition are discussed, and the management strategies outlined.

Lymphangiomatous cyst of the adrenal gland: an unusual cause of flank pain.

Cysts of the adrenal gland are rarely encountered in clinical practice. Presenting signs and symptoms are variable. We present a case of an active 46 year old white female with six months history of left flank pain who was found to have a large lymphangiomatous cyst of the left adrenal gland. Curative resection of the cyst and left adrenalectomy were performed with preservation of the left kidney. We include a review of the literature.

Urinary schistosomiasis in Nebraska.

Urinary schistosomiasis, a disease caused by the blood fluke Schistosoma haematobium, is seen in residents of endemic areas of Africa and Southwest Asia. Two cases are described, one in a twelve year old boy and another in a forty-four year old man. This type of infection is often indolent but can have significant long-term sequelae such as urinary obstruction and bladder cancer. The recent increases in U.S. immigration of persons from the areas endemic to schistosomiasis behoove physicians to remember this disease when dealing with patients native to these lands.

Endoscopic laser lithotripsy: safe, effective therapy for ureteral calculi.

At our lithotripsy department more than 400 patients with renal or ureteral calculi have been treated with a pulse-dye laser for stone disease. We review our experience during an 11-month period when a total of 223 patients was treated. Of these patients 204 whose ureteral calculi were treated by laser lithotripsy are available for followup. The data in this series demonstrate that a miniaturized ureteroscopic system is of paramount importance in laser lithotripsy, allowing access into the ureter without dilation in the majority of patients (165 of 204). Lack of dilation is associated with a decrease in pain and postoperative hospitalization. Satisfactory stone fragmentation was accomplished in 198 of 204 procedures in this series with use of the laser alone. A low complication rate was observed. Endoscopic laser lithotripsy is a safe, reliable and cost-effective method of therapy for ureteral calculi in a community hospital setting.

Treatment of Salmonella-Arizona-infected turtle eggs with terramycin and chloromycetin by the temperature-differential egg dip method.

Attempts to eliminate Salmonella and Arizona infection from newly hatched turtles were made by dipping fresh eggs in cold solutions of Terramycin and Chloromycetin at 1,000, 1,200, 1,500 and 2,000 mug per ml for either 10, 20, or 30 min. Control groups consisted of hatchings produced from nondipped eggs or eggs dipped in chilled water. In two of the four experiments 5 to 10 eggs were blended on days 15, 30, and 45 post antibiotic dip treatment. Twenty-five to 60 hatchlings from each control or experimental dip groups were held in containers and the water was tested (excretion method) for Salmonella and Arizona every 15 or 30 days for 180 to 210 days after hatching. Representative turtles were homogenized (blending method) to determine if systemic infections were present. All specimens tested were enriched in tetrathionate and selenite cystine broth. Nondipped eggs and water-dipped eggs routinely showed Salmonella and Arizona present in egg homogenate and hatchlings emerging from these eggs excreted these pathogens. Terramycin- and Chloromycetin-dipped eggs were uniformly negative for these pathogens, only if fresh eggs were dipped. Bacteriological assay of container water and whole turtle homogenate from hatchlings were negative for Salmonella and Arizona if eggs were dipped in 1,000 mug of Terramycin early in the egg laying season or if eggs were dipped in 1,500 or 2,000 mug of Terramycin per ml late in the egg laying season. The results of temperature-differential egg dip studies suggest that this is a feasible and promising method by which to eradicate Salmonella and Arizona from the turtle.

Evaluation of methods for the isolation of Salmonella and Arizona organisms from pet turtles treated with antimicrobial agents.

Turtles infected with and actively excreting Salmonella-Arizona organisms were treated with various concentrations of both Neo-Terramycin (N-Te) and Terramycin (Te) (Pfizer) for various periods of time and then tested for the presence of these pathogens by two methods, excretion and blending. Turtles treated with 200 mug of Te per ml of container water for 9, 12, or 14 weeks, whereas when representative turtles from treatment groups were blended 72 h posttreatment these organisms were isolated from the whole turtle homogenate. Salmonella and Arizona could be recovered from homogenate prepared from turtles treated for 7 and 14 days with 400, 800, or 1,000 mug of Te or N-Te per ml. These findings suggest that the blending methods is more sensistive than the excretion method for the detection of Salmonella-Arizona in the treated turtle.