Assessment of the safety of regular DDAVP therapy in primary nocturnal enuresis.

A group of 7 patients with refractory primary nocturnal enuresis on long-term DDAVP therapy (mean 13 months) were submitted to a standard water deprivation test in conjunction with a hormone profile and routine haematological and biochemical investigations. No abnormalities were demonstrated, which suggests that the drug is safe in this clinical situation.

Flushing. Long-term side effect of orchiectomy in treatment of prostatic carcinoma.

Orchiectomy is considered a safe and simple procedure, free from serious side effects, in the treatment of prostatic carcinoma. We have found that 76 percent of patients experienced postorchiectomy flushes, and 30 percent believed their symptoms warranted treatment. The flushing started at between one and twelve months (average 2.7 months) postoperatively and lasted an average of thirty months or, in some cases, up to the time of death (average 33 months). No single precipitating factor was found, and no single hormone seemed to be responsible. Special attention was given to the nonflushers to see whether or not it was of prognostic significance, and it appears that the slight elevation in the testosterone level sufficient to prevent flushing may indicate a nontesticular source of androgen. Medroxyprogesterone acetate (Provera), 5 mg twice daily, appeared to be an effective agent for controlling the flushes.

Genitourinary tuberculosis in patients under twenty-five years of age.

There were 29 patients under the age of twenty-five years in a series of 230 patients with genitourinary tuberculosis. Younger patients were less likely to have had previous tuberculosis but more likely to have a family history of tuberculosis. Abdominal or loin pain was a more common presenting feature in those under twenty five, and they were less likely to require surgery than older patients.

Intravesical formalin in intractable haematuria.

Eleven patients with bladder tumours classified T2 (2 cases), T3 (6 cases) or T4 (3 cases) - and 3 patients with radiation cystitis - were assessed as being beyond the scope of even palliative surgery, severe haemorrhage being present in all cases. One patient was treated by total cystectomy and urinary diversion 21 months after intravesical formalin installation. Palliative haemostatic treatment was instituted in all cases by intravesical instillation of a 10% formalin solution under general anaesthesia. Two patients received 3 and 5 instillations respectively, the former over 3 weeks and the latter over 9 months. The bladder was filled completely and an indwelling catheter introduced, the formalin solution being left in the bladder for from 3 to 20 minutes (mean: 13 minutes). Haematuria was absent after from one to 21 days (mean: 5.3 days) in 13 cases. The 14th patient died before arrest of haemorrhage. Survival after instillation was from 3 days to 32 months (mean 6.8 months). The outcome was fatal within 3 months or less in 8 cases and 6 patients died within 2 months of acute renal failure, one within 3 days of instillation. In 5 cases the treatment with formalin reduced bladder capacity to less than 100 ml. Other complications included acute infection of thigh, ruptured bladder, retroperitoneal fibrosis and severe frequency and nocturia (1 case each), and this procedure should therefore be reserved for terminal cases unable to support more aggressive therapy.

Genito-urinary tuberculosis in Glasgow 1970 to 1979: a review of 230 patients.

Two hundred and thirty patients with genito-urinary tuberculosis presenting between 1970 and 1979 were reviewed. In 22 per cent there was a history of previous tuberculosis and a family history in 14 per cent. Night sweats and weight loss were uncommon. The mean duration of medical treatment was 17 months. Surgery was necessary in 49 per cent of patients but reconstructive procedures were only performed in 7 per cent of cases. The mean follow-up period after diagnosis was 46 months. Patients with initial renal calcification were followed-up for a similar time to those with no calcification. Complications during follow-up were no more common in those with initial renal calcification than in those without this feature. With the exception of 1971 and 1972, there was a steady incidence of 20 or so new cases of genito-urinary tuberculosis per year in Glasgow.

Tuberculous epididymo-orchitis. A review of 20 cases.

Twenty cases of tuberculous epididymo-orchitis, occurring in Glasgow from 1970 to 1979, were reviewed. Five gave a history of previous tuberculosis and 10 showed no evidence of tuberculous infection in their urine. In half of the cases the diagnosis was made from histological material. Only five patients had normal intravenous urograms and five required subsequent major surgery for upper urinary tract disease. Tuberculosis should be considered in the differential diagnosis of a scrotal swelling even in the absence of a history of previous tuberculosis.

Co-trimoxazole and trimethoprim in complicated urinary tract infection.

Previous work has suggested that co-trimoxazole may be superior to trimethoprim in the treatment of complicated urinary tract infection. A prospective study has been done to assess the relative value of the drugs in this situation using trimethoprim at higher than normal dosage. Fifty three patients (33 women and 20 men) were randomly allocated to either a fourteen-day course of co-trimoxazole tabs, 2 twice a day (27 patients) or trimethoprim 250 mg twice a day (26 patients). After patient withdrawals from the study, 17 (77%) of the co-trimoxazole group achieved a sterile urine three weeks after starting treatment compared with 15 (65%) in the trimethoprim group (X2 = 0.80). When those patients with sterile urine at three weeks who could be reassessed four weeks later were analyzed, 8 (89%) of the co-trimoxazole patients maintained a sterile urine against 7 (58%) in the trimethoprim group (X2 = 1.09). Although statistical significance was not attained, the results suggest that even at increased dosage, trimethoprim would not appear to be as efficient as co-trimoxazole in complicated urinary tract infection.

Squamous cell carcinoma of bladder. A review of 114 patients.

A retrospective review of 114 cases of squamous cell carcinoma of bladder presenting in Glasgow between 1964 and 1978 is described with emphasis on treatment and survival. Ninety-seven patients (92.4%) were found to have invasive tumours (T2-T4) at diagnosis. Metastatic disease was confirmed in only 10 patients (8.8%). Only 23.8% of patients were alive one year after diagnosis, the overall 5-year survival rate being 1.9%. The 5-year survival rates for patients with T2 and T3 disease following radical radiotherapy were 16.7 and 4.8% respectively. No conclusions concerning the role of total cystectomy could be drawn from this series because of the small number of patients undergoing the operation, but a review of the literature suggests this may be the treatment of choice.

The treatment of advanced carcinoma of the bladder with combination chemotherapy.

Thirty patients with advanced T4 transitional cell carcinoma of the bladder were treated in a prospective randomised trial with combination chemotherapy. Sixteen patients received cyclophosphamide, doxorubicin (Adriamycin) and 5-fluorouracil, whilst 14 patients received methotrexate, doxorubicin and 5-fluorouracil with folinic acid rescue. There were no complete or partial responses to either regime and there was progression in all patients. The 2 regimes were shown to be relatively non-toxic but failed to alter the natural course of the disease.

Cryptorchism in cerebral palsy.

This study examined an association between cerebral palsy and cryptorchism. Twenty-one (53.8%) in a group of 39 severely disabled males exhibited cryptorchism to a varying degree. A striking feature was the high proportion with an impalpable testis on one (15.4%) or both (7.7%) sides. Early damage to the fetal hypothalamo-pituitary axis is suggested as the likely causative factor.

Intermittent thiazide therapy in recurrent stone formers.

An intermittent thiazide regimen consisting of bendrofluazide, 5 mg. daily, with potassium supplements was given to 17 recent stone formers for period ranging between fifteen months to eight years (mean four years two months). No new stone formation was evident in 8 patients with no radiologic evidence of stones on starting treatment who previously had a stone incidence rate of 0.59 incidents per patient-year. In an additional 9 patients with radiologic evidence of stones on starting treatment the stone recurrence rate was reduced from 0.45 to 0.34 incidents per patient-year. Mild side effects were observed in 2 patients which resolved on discontinuing the treatment regimen.

Computer-assisted diagnosis of acute Crohn's diseases.

A study comparing the symptoms and signs of patients with acute Crohn's disease and those with acute appendicitis and intestinal obstruction is reported and a preliminary evaluation of computer-assisted diagnosis in this problem is given. There are significant differences between the three conditions. However, the accuracy of computer-assisted diagnosis in Crohn's disease is reduced by the high false positive rate of diagnosis in both appendicitis and intestinal obstruction. Computer accuracy in Crohn's disease may increase when further information is available to extend the data base.

Dextran and intermittent pneumatic compression in prevention of postoperative deep vein thrombosis: multiunit trial.

Seven general surgical units co-operated in a clinical trial of dextran 70 and pneumatic calf compression alone and in combination in the preventing of 125I-fibrinogen-detectable deep vein thrombosis in 305 patients. Both dextran regimens were significantly more effective than pneumatic compression alone. Pulmonary embolism was diagnosed in 14 patients, but there was no significant difference in incidence among the three treatment groups. In patients receiving dextran there was no greater median operative blood loss but there was a significantly greater incidence of postoperative bleeding complications.