A method for making rapid changes of superfusate whilst maintaining temperature at 37 degrees C.

We have developed a technique for making a rapid solution change, whilst at the same time maintaining the temperature of the preparation at 37 degrees C. It is technically difficult to use rapid solution changes when experiments are performed at normal mammalian body temperature. As a solution is heated from room temperature to 37 degrees C, gas bubbles form in the rapid-flowing solution streams, and these disturb a cell or attached recording pipettes. We describe a system that has been developed to eliminate these problems. We show how to construct the different components of the system, and we have designed an electronic circuit to control solution changes. We have performed tests to characterise the function of this system. Solution flow out of the nozzle of the device (0.88 ml min-1, linear flow velocity 11.6 cm s-1) caused a fall in the steady-state temperature at the experimental preparation of only 0.3 degrees C. The device which takes between 0.5 and 1 s to completely change the superfusate of a single cell, was used routinely with five different experimental solutions. This system may be valuable in studies which require rapid solution changes to be performed at a normal mammalian body temperature.

Ultrasound in renal carcinoma: an essential in follow-up.

A total of 115 patients underwent radical nephrectomy for renal carcinoma in this hospital between 1983 and 1990. Follow-up was available in 113 cases (mean 27 months, range 0-93). The overall actuarial survival was 66% at 2 years and 53% at 5 years. Fifty-three patients have been followed up with annual abdominal ultrasound over the last 2 years. Abnormal ultrasound scans were reported in 6 patients (11%) on follow-up. Two had para-aortic lymph node recurrence amenable to further surgery. One patient developed a metachronous tumour and a partial nephrectomy was carried out. Three patients had local recurrence not amenable to further surgery. Ultrasound and computed tomography have found an invaluable place in the pre-operative diagnosis and staging of renal carcinoma. Sixteen of 113 tumours were diagnosed by ultrasound or intravenous urography carried out for some other purpose; 8 were less than 5 cm in diameter and 12 were T category N0M0V0. The 2-year survival rate in this group was 85% (mean 30 months, range 19-67). We consider the routine follow-up of renal carcinoma with clinical examination and annual chest X-ray to be inadequate. The application of ultrasound in the follow-up of these patients has provided a valuable adjunct to our clinical practice. It has allowed the prompt diagnosis of lymph node recurrence or metachronous tumour amenable to secondary surgery with the potential for improved survival in this group of patients. We consider this to be the logical extension of the value of ultrasound in the pre-operative diagnosis of renal carcinoma.

Partial nephrectomy: an option in calculus disease?

Thirty-seven patients treated by partial nephrectomy for calculus disease between 1971 and 1986 were reviewed retrospectively. Of the 25 patients available for analysis, 20% developed immediate surgical complications, 20% had residual post-operative stone and 33% developed true ipsilateral stone recurrence during the period of follow-up. Our results from partial nephrectomy for calculus disease are compared with the results of treatment by percutaneous nephrolithotomy and extracorporeal shockwave lithotripsy. It was concluded that partial nephrectomy should be reserved for situations where stone disease is associated with anatomical abnormalities which cannot be treated by the newer modalities of stone management.

Modified nephro-ureterectomy. Long-term follow-up with particular reference to subsequent bladder tumours.

Nephro-ureterectomy is the standard treatment for transitional carcinoma of the renal pelvis and caliceal system. In recent years a modification of the conventional two-incision technique has been described in which the intramural ureter is resected endoscopically and the remaining ureter is removed in continuity with the kidney through a single loin incision. Twenty-one patients had their renal pelvic tumours treated by this modified technique between 1970 and 1983. Of 16 patients available for analysis, 37.5% subsequently developed bladder tumours. It was concluded that this modified technique has no greater incidence of subsequent bladder tumour development than the conventional technique of nephro-ureterectomy, whilst giving considerable benefit to the patient.

Endoscopic bladder transection.

Endoscopic bladder transection has been performed in 30 patients with symptoms as a result of unstable bladder activity. The symptomatic improvement produced justifies the use of this new operation which should replace the open procedure.

Retroperitoneal fibrosis: practical problems in management.

Nineteen patients with retroperitoneal fibrosis were reviewed. Eighteen patients had idiopathic disease and one had taken methysergide for 15 years. Primary bilateral ureterolysis was undertaken in 13 cases. Five patients developed problems due to extension of their disease after surgery. Low dose steroids may be useful in the treatment of patients with raised sedimentation rates after surgery in order to prevent late manifestations of the disease.

Total cystectomy--a review.

Anlysis of 99 total cystectomies for malignant disease over a 10-year period in one unit has been carried out, in order to clarify the place of the operation in the overall management of the disease and to assess the quality of life in the patients so treated.

Urinary infection after micturating cystography.

Out of 87 patients who underwent micturating cystourethrography (M.C.U.) 14 had infection at the time of the procedure, and infection later developed in 18 patients. The occurrence of post-M.C.U. infection was significantly influenced by whether the patient was on antibacterial treatment at the time of the procedure, but not by the sex of the patient, difficulty of catheterisation, or radiological abnormality. Hence, antibacterial prophylaxis should be given, and subsequent urine culture is mandatory.

Abacterial cystitis.

5 young male patients with all the symptoms and signs of genito-urinary tuberculosis but in whom no organism could be cultured from the urine are described. 4 of them rapidly responded to a course of tetracycline. Various organisms are suggested as a cause of this condition, and careful bacteriological investigation in the future might discover the cause.

Price of prostatectomy.

Three different urological units found that transurethral prostatectomy required a hospital stay at least one week shorter than open Millin or transvesical prostatectomy. By making transurethral resection more widely available there could be a substantial financial saving; but more surgeons would have to specialize in urology.