Antibiotic concentrations in the urine from kidneys of unequal function.

Little attention has been given to whether an effective concentration of an antibiotic is obtained in the urine of a patient without azotemia who has one poorly functioning kidney and a contralateral normal kidney. This study was undertaken to measure the concentration of various antibiotics in the urine from both kidneys of 20 patients with unilateral renal disease and a radiologically and functionally normal contralateral kidney. Prior to ureteric catheterization each patient received a single parenteral dose of an antibiotic. The peak urinary drug concentration from the damaged kidney per unit of its creatinine clearance exceeded that for the normal kidney for 11/13 patients treated with an aminoglycoside and 6/7 given a cephalosporin. The most severely damaged kidney had a creatinine clearance of 0.6 ml/min. This patient received sisomicin and the peak urinary concentration was only 1.8 micrograms/ml. If a damaged kidney has a creatinine clearance less than 10-15 ml/min it would seem more appropriate to use a cephalosporin rather than an aminoglycoside antibiotic.

A renal lesion in a woman with Reiter's disease.

A 17 year old girl with Reiter's disease had extensive involvement of the entire urinary tract in addition to arthritis, vaginitis, and ocular involvement. In addition to a severe urethritis, cystitis and ureteritis there was evidence of glomerular and tubular dysfunction and abnormalities were seen on renal biopsy. The patient was treated with a five week course of doxycycline and made a slow but complete recovery.

Acute renal artery occlusion.

Eeven cases of acute renal artery occlusion are reviewed. The clinical presentation and features of the condition are discussed and reasons for delays in diagnosis are examined. Two cases in whom active treatment was carried out are described in detail. Acute renal artery occlusion is most common in patients with severe cardiac disease and this may influence decisions on treatment.

Carcinoma of the urachus: report of four cases and review of the literature.

Four cases of urachal carcinoma are presented. The features of this uncommon disease are outlined and the literature is reviewed briefly.

Prostate cancer mortality in New Zealand: the past and projections for the future.

BACKGROUND: Ageing male populations and improved diagnosis of early stage disease have contributed to the increasing incidence of prostate cancer observed in many Western countries. The clinical significance of these diagnosed cancers is, however, currently unclear. The aim of this study is to examine trends over time in prostate cancer mortality as an indicative measure of clinically significant disease during a 29-year period (1965-93) which preceded the extensive use of early cancer diagnostic techniques or radical therapy protocols. METHODS: Age-specific and age-standardized rates were calculated for each year during the study period, using routinely collected mortality and demographic data. A Poisson regression model was used to describe trends in the age-specific rates over time to predict numbers of prostate cancer deaths and the lifetime risk of death over the next 20 years. RESULTS: Significant annual increases ranging from 1 to 2.6% were found for age-specific prostate cancer mortality rates over the 29-year time period, with the largest increases experienced in the younger age groups at risk. Based on projected population ageing and growth alone, annual numbers of prostate cancer deaths are predicted to increase from 487 in 1993 to 664 by the year 2006 and then to 833 by the year 2016. Continuation of the observed increases in age-specific mortality rates would result in a predicted 797 deaths by the year 2006, while an expected 1115 deaths is calculated for the year 2016. This would correspond with an increase in the lifetime risk of death from prostate cancer from a present 3.7 to 4.5% in 10 years and 6.2% in 20 years. CONCLUSIONS: The changing pattern of prostate cancer mortality described in this study is likely to represent a significant increase in the incidence of clinically significant disease. This will have a significant impact on the ageing New Zealand male population, and important implications for the provision of effective treatment and preventive strategies.

Non-steroidal anti-inflammatory drugs and prostate cancer progression.

Experimental studies have suggested that the biosynthesis of arachidonic acid-derived eicosanoids such as prostaglandin E2 via the cyclo-oxygenase pathway may play a significant role in supporting cell proliferation in human prostate cancer cell lines. However, the aetiological significance of this for clinical prostate cancer has remained unclear. In particular, the potential for prostate cancer chemoprevention using nonsteroidal anti-inflammatory drugs (cyclo-oxygenase inhibitors; NSAIDs) has received little attention. The purpose of our study was to investigate associations between prostate cancer risk and use of NSAIDs. A population-based case-control study was carried out over 13 months from 1996 in metropolitan Auckland, New Zealand. A total of 317 newly diagnosed prostate cancer cases (including 192 "advanced" cases) representative of all cancer cases in the study population were identified from urology clinic referrals and histology reports. A total of 480 age-matched controls were recruited following random selection from the study population using electoral rolls as the sampling frame. After adjusting for potential confounding by socio-economic status and dietary fat consumption, there was a trend toward reduced risks of advanced prostate cancer associated with regular use of total NSAIDs (RR = 0.73; 95% CI 0.50-1.07) and total aspirin (RR = 0.71; 95% CI 0.47-1.08). However, these associations failed to reach statistical significance at the usually accepted levels. Weaker inverse associations were found for total prostate cancers, which included a number of small, low-grade tumours of less clinical significance. These findings lend support to proposed underlying aetiological hypotheses which imply a role for cyclo-oxygenase activity in prostate cancer progression.

Testicular biopsy in evaluation of male infertility.

Testicular biopsy findings in 100 infertile men were correlated with the clinical findings. Mild or moderately severe tubular lesions were seen in 57 cases and severe changes in 43. Clinical examination and semen analysis were no guide to the severity of the testicular lesion. Though patients with normal sized testes more commonly had mild tubular lesions, many were severe. Patients with small testes more often had severe lesions but some had only mild tubular changes. Biopsy findings in both aspermic and oligospermic patients ranged from normal to a complete loss of germinal tissue.Testicular biopsy is advocated in infertile men for the complete assessment of the case and for identifying those which are potentially treatable. Patients with a severe lesion can be spared further investigations. The choice and results of treatment are discussed, particularly the surgical treatment of varicocele or obstruction. Only patients with a mild or moderate testicular tubular lesion should participate in future trials with drugs for male infertility.

A mesoblastic nephroma with hypercalcaemia.

A 14 week old female infant who presented with a mesoblastic nephroma was found to be hypercalcaemic. This was corrected prior to removal of the tumour and serum calcium concentrations remained within the normal range postoperatively. Hypercalcaemia is a life threatening complication of mesoblastic nephromas and should be investigated in all cases.

Pituitary function in normoprolactinaemic infertile men receiving bromocriptine.

A double blind trial of bromocriptine 7.5 mg daily versus placebo was carried out in ten infertile men. Pretreatment basal plasma prolactin, thyroid stimulating hormone (TSH) testosterone and luteinizing hormone (LH) concentrations were normal, but plasma follicle-stimulating-hormone (FSH) was raised in four individuals. After 4 months treatment with bromocriptine a significant fall in plasma prolactin was observed (P less than 0.01), both under basal conditions and following thyroid stimulating hormone releasing hormone (TRH). Basal plasma gonadotrophin, testosterone and thyroid stimulating hormone (TSH) concentrations did not alter. No change in sperm density, volume or motility was noted. However an apparent fall in the peak plasma LH (but not FSH) response to gonadotrophin releasing hormone (LHRH) was observed in patients receiving bromocriptine. This reduction in plasma LH responsiveness was significant when compared with the baseline response (P less than 0.05) but failed to reach significance when compared with the placebo response. It is concluded that prolonged bromocriptine therapy in normoprolactinaemic men does not suppress FSH secretion, and any reduction in plasma LH responsiveness to LHRH is not accompanied by a significant fall in plasma testosterone.

Trophoblastic metaplasia in urothelial carcinoma of the bladder.

Trophoblastic differentiation in bladder carcinoma is reported in four patients. Plasma gonadotrophin (beta subunit of HCG), measured in three patients, was elevated. In one patient treated with cisplatin, vinblastine and bleomycin, the beta HCG level fell significantly but progression of malignant disease was not arrested.

Clam cystoplasty for the overactive bladder: a review of 23 cases.

A clam enterocystoplasty was performed for refractory urge incontinence due to either idiopathic instability (13 patients) or neuropathic hyperreflexia (10 patients). Twelve patients became dry and appliance free. Of the remaining 11 wet patients, seven developed low pressure reservoirs, of whom five had stress incontinence and two had overflow incontinence. The other four patients had persistent symptomatic involuntary phasic contractions and ongoing urge incontinence. The magnitude of the surgery and the voiding dysfunction associated with the relative lack of motivation of elderly patients made the operation less successful and more hazardous in those over the age of 65. Successful outcome could be improved by careful patient selection and by performing an antistress incontinence procedure, such as implantation of an artificial urinary sphincter cuff or a cystourethropexy, where there is associated bladder outlet incompetence.

A population-based study of clinical and pathological prognostic characteristics of men with familial and sporadic prostate cancer.

OBJECTIVES: To compare traditional prognostic characteristics of familial vs sporadic prostate cancers and to investigate potential detection biases arising from differences in the use of screening and investigative procedures. PATIENTS AND METHODS: Familial and sporadic cancers were identified in a population-based sample of incident prostate cancers (total 318) in Auckland, New Zealand. To examine the potential for detection biases in these comparisons, the sociodemographic and clinical characteristics were determined according to family history status for a sample of 959 patients newly referred to Auckland urology clinics by general practitioners for the investigation of prostate-related conditions. RESULTS: Compared with sporadic prostate cancers, familial cancers were more likely to be diagnosed in patients at a younger age (P=0.05), after asymptomatic serum prostate-specific antigen (PSA) screening (P=0. 02), and to include a lower proportion with extraprostatic disease (P=0.009) and serum PSA levels before diagnosis of >20 ng/mL (P=0. 04). This was consistent with the observed trend for patients referred to urology clinics with a positive family history to be of higher socio-economic and educational status and to more frequently undergo screening and biopsy investigation. CONCLUSION: Familial prostate cancers appeared to be diagnosed at an earlier stage of disease progression in this study population, possibly as the result of the higher socio-economic status and greater use of screening and investigative procedures amongst patients reporting a positive family history. These features reduce the validity of cross-sectional comparisons of prognostic variables for familial vs sporadic prostate cancer and emphasize the need for further longitudinal prognostic studies.

Renal vein renin concentration in the hypertension of unilateral reflux nephropathy.

Hypertension is a frequent complication of reflux nephropathy. The cause of this hypertension is unknown. Our study was undertaken to assess the possible role of the renin-angiotensin system in the hypertension associated with unilateral reflux nephropathy. We selected for study 17 normotensive and 12 hypertensive patients with strictly unilateral reflux nephropathy. There were 3 normotensive and 2 hypertensive patients with a renal vein renin ratio exceeding 1.5. Of these 3 normotensive patients 1 had evidence from divided renal function studies to suggest functional renal ischemia. No consistent evidence was obtained to support the concept that the renin-angiotensin system has a primary role in the non-malignant hypertension of unilateral reflux nephropathy.