Cellular ascorbate depletion in healthy men.

To clarify the relationship of plasma ascorbic acid to cellular ascorbic acid levels, we determined plasma, lymphocyte, buccal cell and semen ascorbic acid in eight healthy men consuming controlled ascorbic acid intakes of 5, 10, 20, 60 or 250 mg/d over 13 wk while living in a metabolic unit. Levels of ascorbic acid in all four specimen types were significantly lower during the three lowest intakes (5, 10, or 20 mg/d) compared with the 60 or 250 mg/d intakes, but only plasma and lymphocyte ascorbic acid levels discriminated between these intakes unequivocally and with no overlap. Priority for maintenance of intracellular lymphocyte ascorbic acid was indicated by rapid repletion of lymphocytes compared with plasma and semen at 60 mg/d intake. Strong correlations of plasma with lymphocyte ascorbic acid within individuals indicated that plasma levels would reliably reflect low lymphocyte levels in nutrition monitoring surveys. Buccal cell ascorbic acid may be useful as a noninvasive screening test for ascorbic acid deficiency. Semen and sperm qualities were unchanged despite an average decline in semen ascorbic acid to 24% of baseline. Short-term ascorbic acid depletion in healthy men did not adversely affect sperm qualities related to fertility nor did moderate supplementation improve them.

Management of pregnancy after major urinary reconstruction.

Major reconstructions of the urinary tract are being performed with increasing frequency. However, published experience concerning pregnancy after urinary reconstruction is limited. Complications in women who have undergone such complex procedures may endanger them or their fetuses and can disrupt the reconstruction or impair renal function. To counsel better those patients who have undergone urinary reconstruction and who desire to bear children, and to develop an approach to the management of their pregnancies, we reviewed the available literature. We found that the incidence of complications was low during pregnancy after a genitourinary reconstruction; the majority of women had an uneventful pregnancy and vaginal delivery. Close observation of renal function and prophylaxis against urinary tract infection during pregnancy are recommended. Elective cesarean is advised for women who have had a reconstruction of the bladder neck or urethra or who have received an artificial urinary sphincter. Urologists and gynecologists must continue to report the outcome of pregnancy in their patients who have undergone reconstruction so that we may develop meaningful data about the incidence of complications.

Biopsy-cucumber unit: improved method for preparing bladder biopsy specimens.

Specially prepared segments of thinly sliced cucumber, serving as tissue mounts, facilitate the histologic processing of bladder biopsy specimens.

Allergic reaction to protamine: a late complication of elective vasectomy?

Nucleoprotamines are a normal component of human sperm cells. Antibodies against these protamines develop in 22 to 33 per cent of patients undergoing elective vasectomy. These antibodies, in turn, have been shown to cross-react with medicinal protamines, which are extracted commercially from the testes of salmon and certain other fish. This cross-reactivity against protamines raises the possibility that patients who have undergone elective vasectomy may be at increased risk of an allergic reaction developing if they are later exposed to protamine as a medication. Since medicinal protamines currently enjoy widespread clinical use, this information should be borne in mind by those clinician using protamine and by urologists when counselling patients concerning elective vasectomy for sterilization.

Triamterene stone: advantage of crystallographic analysis.

Microscopic crystallographic analysis of renal calculi provides clinically useful information concerning the pathogenesis of stone disease and is, therefore, superior to conventional chemical analysis of stones. The advantages of crystallography, performed at a centralized, experienced stone-analysis center, are highlighted by the recent discovery of triamterene deposits in kidney stones. Deposits of other medications and their metabolites have also been uncovered. Two case reports are presented, the clinical implications of these and related findings are discussed.

External beam radiotherapy for adenocarcinoma of the prostate: a clinical followup.

Post-irradiation biopsies were done on 68 patients who had received curative external beam radiation therapy for adenocarcinoma of the prostate. These patients were evaluated to determine subsequent rates of disease progression and patients survival. Mean followup was 5 years. Results revealed that 1) residual tumor present 12 months after therapy does not disappear, 2) advance in tumor grade occurred in 19 of 39 patients (49 per cent) with positive biopsies after therapy, 3) patients who had positive biopsies after therapy had a greater chance for disease progression (11 of 39 cases or 28 per cent) than patients with negative biopsies (4 of 29 cases or 14 per cent) and 4) hormonal therapy started when a positive biopsy was obtained appears to delay onset of disese progression.

Perivesical mass and vertical bladder caused by massive prostatic enlargement.

Massive prostatic enlargment may present with the radiographic appearance of a perivesical mass and pear-shaped bladder. An explanation of this appearance, based on the compouted tomographic findings, is offered. We discuss the differential diagnosis.

Chylous ascites: an unusual complication following retroperitoneal lymphadenectomy for testis tumor.

A 32-year-old man who had chylous ascites 6 weeks after retroperitoneal lymphadenectomy for embryonal cell carcinoma of the testis is reported. To our knowledge there have been only 4 previous reports of this interesting and unusual complication. Diagnosis, pathophysiology and management are discussed.

Surgical injury to ureter.

The incidence of surgical injury to the ureter varies from as low as 0.5% to as high as 30%. By being aware of various pitfalls in prevention, recognition, and treatment, the operating surgeon may perhaps minimize the incidence of surgical injuries to the ureter or their sequelae. The authors' experience with twenty-four surgical ureteral injuries is discussed and 5 cases are reported. In spite of a thorough knowledge of embryology, anatomy, and pathology predisposing to ureteral involvement, the possibility of ureteral injury must always be kept in mind.