An unusual case of urinary incontinence, ataxia-telangiectasia, and metastatic dysgerminoma: case report and review of the literature.

Ataxia-telangiectasia (A-T) is a rare autosomal recessive disease notable for neurodegeneration, chromosomal instability, and a predisposition to cancer. It presents in childhood with a variable phenotype. We report the first case of an A-T related tumor presenting as urinary incontinence, and the first case of 2-year survival in an A-T patient with metastatic dysgerminoma.

Reduction of paraphimosis with hyaluronidase.

The use of hyaluronidase facilitates reduction of paraphimosis. It acts by dispersing extracellular edema, permitting easy reduction of the foreskin. Its use is applicable both in the hospital and outpatient setting. Hyaluronidase is widely available and keeps well if refrigerated. It is effective for children and adults.

Hemorrhagic cystitis: a review.

Acute, fulminant bladder hemorrhage usually is seen at tertiary care centers in which cancer patients are treated with oxazaphosphorine alkylating agents, particularly cyclophosphamide and isophosphamide. These agents also are used to treat benign conditions, such as lupus erythematosis and Wegener's granulomatosis. Radiation effects from treatment of prostatic or cervical carcinoma can appear for the first time as late as 15 to 20 years after initial treatment. Other iatrogenic causes of bleeding include treatment with penicillins and, rarely, danazol. Occasionally, bladder hemorrhage may be the presenting sign of metabolic disease, such as secondary amyloidosis in rheumatic arthritis. Cases of mild to moderate hemorrhagic cystitis arising in the otherwise healthy patients should lead one to pursue the possibility of environmental toxins, accidental poisoning, recreational drug use or viruses. In all cases the diagnosis should be reserved until more common causes of hematuria, such as bacterial or fungal infection, stones, cysts or tumors, have been ruled out. Prevention of chemotherapeutically induced cystitis ideally will follow careful attention to adequate hydration and the prophylactic use of antitoxins, such as mesna. Treatment, as outlined previously, consists of a series of measures beginning with the most conservative. Intervention thereby is tailored to the gravity of the clinical situation.

Endoscopic urethroplasty: an improved technique.

Endoscopic urethroplasty is an excellent alternative to open repair of the traumatically disrupted posterior urethra. It offers the advantage of limiting surgical trauma to an already scarred urethra and pelvic floor. Our technique also allows fluoroscopic guidance of the recanalization procedure to align the new urethral channel precisely with minimum disruption of the nerves and muscles of the periurethral tissue and pelvic floor. It obviates the need for a second surgeon viewing the urethra from above as has been required in previously described techniques. This procedure allows for maximal preservation of residual post-traumatic continence and erectile function because it minimizes blind passage of instruments.

The prostatic epithelial cell in dysplasia: an ultrastructural perspective.

The histologic features of prostatic duct-acinar dysplasia have been difficult to analyze ultrastructurally, because of the difficulty in properly selecting and processing such small, randomly situated grossly invisible lesions. We have succeeded in identifying dysplastic foci by examination of the cut surfaces of tissue slices under low magnification. Dysplasia foci were excised from the slices and were compared to adjacent normal tissue by both light and electron microscopy. By electron microscopy (EM), normal secretory cells were filled with myriad tiny clear vacuoles, which were markedly diminished to absent in the cytoplasm of dysplastic cells. Both apocrine and eccrine secretion characterized normal epithelium and were diminished in dysplasia. EM showed striking features of nuclear abnormality more prominently than light microscopy, and qualitative basement membrane abnormalities were revealed. By EM analysis, dysplastic epithelium resembled that of invasive carcinoma more than normal epithelial cells.

Skin sensitization potential of allyl methacrylate in guinea pigs.

The skin sensitization potential of allyl methacrylate (AMA) was studied in Hartley albino guinea pigs. Two groups of guinea pigs (10 per compound) were subjected to repeated insult patch tests either with AMA or with dinitrochlorobenzene (DNCB). All guinea pigs treated with DNCB (positive control) were sensitized. None of the guinea pigs treated with AMA exhibited any evidence of sensitization and no reactions attributable to AMA were elicited as a result of exposure during the insult phase of the patch test. Based on these results, it is concluded that allyl methacrylate is not likely to be a sensitizer and exposure to this material in industrial handling situations will not present an appreciable risk of human skin sensitization,

Ion microanalysis of cells.

The application of ion microanalysis (IMA) to the chemical characterization of freeze-fixed, freeze-dried cells is reviewed. Particular emphasis is given to pathological studies involving the determination of the chemical composition of isolated cells (e.g. rabbit alveolar macrophages--RAMs) exposed in vitro to toxic species (e.g. Pb3O4 particles). Ion microscopic results indicated that lead from Pb3O4 migrated into the RAMs and subsequently formed phosphorous-containing compounds. Quantitative comparisons of the relative concentrations of physiologic elements in Pb3O4-treated versus control RAMs also were made using ion microanalytical techniques. The Pb3O4 results illustrate that the three-dimensional analysis capabilities of the IMA may be exploited for the in situ observation of the penetration of xenobiotic agents into cell interiors and their subsequent intracellular chemistry. The potential advantages of ion microanalysis for the characterization of cells include high elemental sensitivity (including low atomic number elements and diffusible ions), broad elemental coverage, three dimensional analysis, and isotopic information. The major limitations include non-idealities of the ion sputtering process, the constraints on the lateral resolution available to identify subcellular features, and the difficulties inherent in the determination of absolute elemental concentrations.

Acute toxicity of lead particulates on pulmonary alveolar macrophages. Ultrastructural and microanalytical studies.

Although it is well established that respiratory uptake of lead-containing particles plays a substantial role in the epidemiology of plumbism, relatively little is known about the role of the pulmonary alveolar macrophage in lead poisoning. An in vitro system was designed to investigate the effects of lead oxide particles of respirable size on the rabbit alveolar macrophage. The studies were concerned with the intracellular solubility of PbO and Pb3O4 and changes in fine structure attributable to lead toxicity. The distribution of phagocytosed lead and its intracellular reprecipitation complexes was established by electron microprobe analysis and secondary ion mass spectroscopy in conjunction with transmission electron microscopy, scanning electron microscopy, scanning transmission electron microscopy, and backscatter imaging. It was found that Pb3O4, PbO and PbO-coated particles were ingested by the rabbit alveolar macrophages and that each of these lead oxide compounds produced similar damage to the fine structure of the cell. Swelling of the mitochondria, nuclear membrane, and endoplasmic reticulum was common, as well as were characteristic reprecipitation complexes of lead, phosphorous, and calcium within the nuclear heterochromatin and cytoplasm of the cell. The precipitation complexes were not seen in cells incubated with the particles if phagocytosis was blocked by 0.22-microns, membrane filters. It was concluded that phagocytosis of these lead oxide particles was necessary to produce the cytopathic changes. It is suggested that solubilization of lead from the ingested particles in phagosomes of macrophages results in the liberation of intracellular lead with the resultant formation of reprecipitation complexes.