A giant renal artery aneurysm diagnosed post partum.

We report a case of a 5.8 cm. right renal artery aneurysm diagnosed intact 8 weeks post partum. Rupture of a renal arterial aneurysm during pregnancy is a rare but well described catastrophic event. There are no previous reports of an intact renal artery aneurysm diagnosed either ante partum or post partum. To our knowledge, this also represents the largest reported renal artery aneurysm. The aneurysm was repaired successfully with kidney salvage and closure of the fistulous connection to the renal vein.

Cocaine and lidocaine as topical urethral anesthetics.

To evaluate the efficacy of topical cocaine combined with lidocaine as a urethral anesthetic, a double-blind, randomized, prospective study was performed comparing lidocaine combined with cocaine or placebo in male outpatient cystoscopy. Evaluations were based on a scale of 1 to 10, with 1 representing no discomfort and 10 extreme discomfort as judged by the patient, and 1 representing the best tolerance and 10 extreme intolerance as judged by the physician. Patients who received lidocaine plus cocaine reported a mean score of 3.33 for over-all discomfort of cystoscopy. This was not significantly different than for lidocaine alone. This finding indicates a lack of a summation effect in combining topical anesthetics. Patients undergoing repeat examinations were no more comfortable than those undergoing initial cystoscopy but older patients tolerated the procedure significantly better than younger patients.

Renal cell carcinoma in cadaver donor kidney.

A cadaver kidney, reported to contain a "simple cyst," was received from another institution. Frozen section biopsy prior to transplant showed renal cell carcinoma. The contralateral kidney already had been transplanted at the other medical facility.

Inadvertent urethral insertion of a contraceptive suppository.

We report the third case of a vaginal contraceptive suppository that was inserted accidentally per urethral causing severe chemical cystitis.

PIP: A case is reported of intravesical placement of a vaginal contraceptive suppository. 2 previously reported cases involving the same brand of suppository and treatment recommendations are reviewed. A 29-year-old woman inserted a contraceptive suppository 15 minutes prior to intercourse. Subsequently, she noticed transient, poorly localized burning that had not been present before she used the suppository. The woman had no history of urinary tract infection or similar symptoms. She awakened 4 hours later with intense urethral pain and inability to void. Catheterization was performed 1 hour later, yielding grossly bloody urine, following which she was able to urinate. Pelvic examination was normal, and an x-ray was negative for a foreign body. The patient complained of severe urgency, frequency, and terminal dysuria 3 days later at follow-up. Physical examination revealed a normally placed urethral meatus calibrated at 21 degrees Fahrenheit. Cystoscopic findings were remarkable for a pale, edematous trigone that stood in sharp contrast to an erythematous pancystitis in the remaining bladder mucosa. No foreign body was present. Capacity was 100 cc, above which marked pain was experienced. The urethral mucosa was inflamed. The patient was treated with trimethoprim-sulfamethoxazole and 50 mg prednisone orally, which was tapered to 10 mg/day. The symptoms persisted 6 days after the mishap with urinary frequency every 30 minutes. Urine culture was sterile. The patient was given 50 mg methylprednisolone sodium succinate in 50 cc sterile water intravesically for 1 hour along with antispasmodics. The patient was asymptomatic by day 14. The clinical findings resemble previously reported cases. The patient had no similar symptoms before or since this episode. Since the urine culture was sterile, and the patient was not taking antibiotics, there was no apparent reason for the severe cystitis. It is strongly believed that urethral insertion of the suppository was the etiology of the symptoms.