ABSTRACT
Following bone marrow transplantation employing conditioning including 'high-dose' cyclophosphamide, 65 patients were studied for the subsequent development of symptomatic haemorrhagic cystitis. There was no protection from the urothelial toxicity of cyclophosphamide metabolites afforded by the concurrent administration of 2-mercaptoethane sodium sulphonate (mesna) if timing errors in administration were made. Other factors which might increase the risk of haemorrhagic cystitis due to cyclophosphamide administration include the prior administration of busulphan to patients with chronic granulocytic leukaemia, in whom the incidence of haemorrhagic cystitis was 36% compared with 4% in all other patients. We have also investigated the use of intravesical prostaglandin E2 as a treatment for haemorrhagic cystitis in eight patients, two of whom appeared to obtain major benefit.
Subject(s)
Bone Marrow Transplantation , Busulfan/adverse effects , Cystitis/chemically induced , Hemorrhage/chemically induced , Adolescent , Adult , Busulfan/therapeutic use , Child , Child, Preschool , Cyclophosphamide/adverse effects , Cystitis/urine , Female , Hematuria/chemically induced , Hematuria/urine , Hemorrhage/urine , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Male , Mesna/adverse effects , Middle Aged , Risk FactorsABSTRACT
In an analysis, by both crystallographic and microbiological methods, of 50 urinary calculi recently removed by surgical operation, 33 proved to be of metabolic origin (mostly calcium oxalate and some uric acid or urate) and 17 of 'infective' origin (struvite, apatite or a mixture of the two). Metabolic stones were usually bacteriologically sterile or contained only small numbers (less than 10(3)/g of stone) of bacteria which did not produce urease, while infective stones always contained urease-producing organisms, usually Proteus mirabilis, in large numbers (greater than 10(5)/g). The combined approach of stone analysis by crystallography and microbiological culture yields more information than conventional techniques on which to base the treatment of urinary calculi and the prevention of their recurrence.
Subject(s)
Urinary Calculi/metabolism , Adolescent , Adult , Aged , Bacteria/isolation & purification , Calcium Oxalate/analysis , Female , Humans , Male , Middle Aged , Phosphates/analysis , Recurrence , Uric Acid/analysis , Urinary Calculi/microbiology , Urinary Calculi/prevention & control , X-Ray DiffractionABSTRACT
A 21-year-old man presented with a 16-year history of recurrent pyrexial episodes and a 5-year history of gynaecomastia. Blood and urinary oestrogen levels were elevated and a mass was found in the upper pole of a retractile right testis. After orchidectomy, oestrogen levels fell, gynaecomastia regressed and the pyrexial episodes ceased. Histological examination of the right testis showed a benign Leydig cell tumour in the upper pole and a germinal cell carcinoma in situ in the remaining part of the testis. Thus a potentially lethal condition was detected at an early pre-malignant phase by virtue of a benign, endocrinologically active tumour. This would seem to be the first report of the co-existence of a Leydig cell tumour and germ cell carcinoma in the same testis.
Subject(s)
Carcinoma in Situ/complications , Gynecomastia/complications , Leydig Cell Tumor/complications , Testicular Neoplasms/complications , Adult , Humans , MaleABSTRACT
In 57 patients with renal allografts the prolonged administration of prednisolone >/= 1 mg/kg/day and azathioprine >/= 3 mg/kg/day caused a significant and persistent fall in serum IgG at all levels of creatinine clearance. The fall in IgG was more striking when creatinine clearance was below 25 ml/min. At lower doses of azathioprine and prednisolone serum IgG fell when the creatinine clearance was less than 35 ml/min, the degree of recovery towards normal being dependent on creatinine clearance and dosage. Post-transplant haemodialysis decreased the depression of IgG, and patients with immediately functioning grafts had minimal IgG depression. An inverse relation between IgG and IgM was observed in some patients. Severe infections and toxicity were associated with the greatest reduction in IgG; leucopenia and thrombocytopenia were not consistently reliable guides to toxicity. The deaths of four patients (7%) were associated with severe infections. Falls in IgG were not related to the rejection process. IgG measurement should be used as a guide to immunosuppression and toxicity in renal allograft patients.
Subject(s)
Immunoglobulin G/analysis , Kidney Transplantation , Adult , Azathioprine/adverse effects , Creatinine/metabolism , Escherichia coli Infections/complications , Female , Graft Rejection , Hematocrit , Humans , Immunoglobulin A/analysis , Immunoglobulin M/analysis , Immunosuppression Therapy/adverse effects , Leukocyte Count , Leukopenia , Male , Middle Aged , Prednisolone/adverse effects , Renal Dialysis , Sepsis/complications , Staphylococcal Infections/complications , Thrombocytopenia , Transplantation, Homologous , Urea/bloodABSTRACT
Of 109 patients admitted to the renal failure programme of the Royal Free Hospital 80.7% were surviving after six years. For patients on home dialysis the four-year rate was 86.2%, more deaths occurring in women than in men. The short-term survival rate of all patients was high-namely, 96.3% at six months and 94.4% at 12 months. Hence large increases in the rate of acceptance of patients as well as successful transplantation are necessary to balance acceptance and loss from this programme.