Results of radiotherapy on ureteric obstruction in muscle-invasive bladder cancer.

OBJECTIVE: To evaluate the effect of radiotherapy on ureteric obstruction due to muscle-invasive bladder cancer. PATIENTS AND METHODS: Retrospective evaluation of the records of 574 patients with muscle-invasive bladder cancer revealed 90 patients (16%) with ureteric obstruction; the obstruction was bilateral in 24%. The effect of radiotherapy was assessed in 55 patients with 68 obstructed kidneys. Six patients with eight obstructed kidneys required percutaneous nephrostomy or ureteric catheters in addition to radiotherapy. RESULTS: Drainage improved in 20% of kidneys and the diverting catheter was withdrawn permanently in one (17%) of the diverted patients. The median survival was 11 months. Irradiation was followed by significant complications in 37 patients (67%). CONCLUSION: The results of this study raise doubts about the assumed beneficial effect of irradiation on ureteric obstruction due to muscle-invasive bladder cancer. The short median survival of 11 months confirms that ureteric obstruction is a poor prognostic factor in muscle-invasive bladder cancer.

Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures.

To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typically soreness over implant and cicatrix, reduced movement of the ankle joint, and strain-related pain. About 75% of these patients reported improvement after removal. The AO mode of fixation, i.e., typically by lateral semitubular plating and transsyndesmotic screw and a medial screw or pins, and the Wiberg-Cedell mode, i.e., typically consisting of lateral single or double cerclage and staple and medial pinning, constituted the principal groupings of the patients. The two groups were comparable. In this series, we found significantly more complaints associated with the AO mode in the postoperative period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.

Hormonal treatment of obstructed kidneys in patients with prostatic cancer.

A review of 1288 patients with previously untreated prostatic cancer revealed 209 patients (16%) with ureteric obstruction; the obstruction was bilateral in 36%. The effect of hormonal treatment was assessed in 88 patients with 120 obstructed kidneys: 77 patients had androgen deprivation or hormonal medication alone and 11 patients needed percutaneous nephrostomy or ureteric catheters in addition. Drainage improved in 58% of the kidneys. The diverting catheter was withdrawn in 9 of the 11 patients after a median of 4 weeks. In all, 95% of patients were discharged. The patients with hormonal therapy alone survived for a median of 26 months (range 1-111), while the patients who also needed diversion survived for a median of 13 months (range 1-28). The median time spent at home was 24 months (0-102) and 10 months (0-23) respectively, presumably reflecting the worse general condition of the patients who required diversion.

[Hyperemesis gravidarum]. / Hyperemesis gravidarum.

On the basis of the literature available, no certain proof can be found that human chorion gonadotropin, progesterone, oestradiol, ACTH, thyreoid patrameters or vitamin B6 are of causal significance for hyperemesis gravidarum (HG). Hyperemesis gravidarum has undoubtedly a considerable psychological basis. The frequency is greatest in industrialized societies and change of environment, in itself, is frequently adequate treatment. There does not appear to be any definite increase in the incidence of malformations in infants of mothers with hyperemesis gravidarum and, similarly, the remainder of the pregnancy usually runs a normal course. All of the forms of treatment are dominated by the tendency to spontaneous remission and great placebo effect. Antihistamines, antiemetics, ginger, change of environment, hypnotherapy and psychotherapy appear to be the best forms of treatment.

Local anesthesia for extracorporeal shock wave lithotripsy: a study comparing eutetic mixture of local anesthetics cream and lidocaine infiltration.

A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.

Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials.

Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy.

PIP: 2 types of randomized trials of a topical melting cream containing a mixture of local anesthetics (EMLA cream) alone or with infiltration with mepivacaine are reported in men having vasectomy. A sequential trial design was used so that the trial could be stopped when statistical significance was reached. EMLA cream was applied to a 20 square cm area and covered with occlusive tape for 30 minutes preoperatively. In the 1st trial 13 men received EMLA cream on one side and mepivacaine on the other. 12 of 13 preferred infiltration because they experienced pain when the incision reached the subcutaneous tissue. Subjects rated the procedure with EMLA cream as more painful than the one on the contralateral side, and 4 stated that they would have preferred the cream before infiltration. The procedure took on average 2 minutes longer to allow for another mepivacaine injection. In the 2nd trial 29 men had either infiltration anesthesia or both. All 15 men who had both anesthetics preferred the combined anesthesia, and 14 of the 15 stated that they would be willing to pay out-of pocket for the cream.

Adenocarcinoma of the prostate and metastatic medullary compression. A retrospective study of 22 patients.

A retrospective study of 709 patients with prostatic cancer was carried out. Twenty-two developed medullary cord compression (an incidence of 3%). All but two of the 22 patients were treated by radiation and 10 had additional hormonal treatment. Ten had some benefit from the treatment, but only 2 of 19 regained their ability to walk. The need for immediate diagnosis and treatment is stressed.

Tetracycline sclerotherapy of hydroceles and epididymal cysts. Long-term results.

Fourty patients with 32 hydroceles and 11 epididymal cysts were treated by aspiration and instillation of tetracycline. After a follow up period of 24-39 months the cure rate was 77%. Most of the early recurrences were the results of chemical inflammation and vanished spontaneously. This group should therefore not be operated on until three months after their initial treatment. As aspiration of the fluid had allowed palpation of the testis and cytological examination, only a small proportion of patients with recurrences wanted further treatment. We therefore recommend tetracycline sclerotherapy because it is quick, easy, safe, and effective in the long as well as the short term.

Long-term results of carbon dioxide laser treatment of meatal condylomata acuminata.

A group of 74 men who underwent carbon dioxide laser treatment of meatal condylomata were observed for an average of 18 months. The cure rate after 1 treatment of isolated meatal lesions was 78%; the presence of external lesions lowered the rate to 32% and additional external and urethral warts to 25%. Following multiple treatments all but 6 patients were cured; 83% of the recurrences developed within 3 months. One urethral and 6 meatal strictures occurred more than 3 months after treatment; 9 patients had a spraying stream many years after treatment and 2 complained of frequency.

[Urethral stricture]. / Urethrastriktur.

The incidence of urethral stricture has increased since the introduction of gonorrhoea to Europe in the 15th century. Nowadays, transurethral instrumentations and catheterisations are responsible for the majority of the urethral strictures. The mechanism is inflammatory or traumatic lesion of the urethral epithelium causing extravasation of urine and fibrosis. The symptoms often suggest to infravesical obstruction. The diagnosis is made from the patient's history in combination with flowmetry, ante- and/or retrograde urethrography, external ultrasound examination or urethral calibration and is verified at urethroscopy. Dilatation is relatively simple but seldom curative and carries a considerable morbidity. Urethrotomy is very common but also hampered with a high rate of recurrence. A technique where urethrotomy is followed by intermittent self-catheterisation or implantation of a selfexpanding wire netting seems promising but needs further investigation. Reconstructive operations in form of a free or pedicled skin island patch, skin tube graft, endourethral free split skin graft, multistaged urethroplasty, meatoplasty and excision of prostatomebraneous stricture are followed by cure in 50-95% of the cases.

[EMLA cream (lidocaine/prilocaine) versus infiltration analgesia with carbocaine (mepivacaine) in vasectomy]. / Emla-creme (lidocain/prilocain) over for infiltrationsanalgesi med Carbocain (mepivacain) ved vasektomi. En randomiseret undersøgelse.

The analgesic efficacy of EMLA cream was compared with infiltration with 1% carbocaine in 13 bilateral vasectomies. Twelve patients preferred infiltration analgesia. EMLA analgesia was only effective in the skin, and had to be supplemented as the incision reached subcutaneous tissue.

Transurethral incision of urethral diverticulum in the female.

A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.