Amyloid tumour of the rectum.

Systemic amyloidosis results in diffuse deposition of amyloid proteins in various organs. Localized deposits in the form of nodules also occur but are rare in the gastrointestinal tract. A localized amyloid deposit in the rectum that was clinically indistinguishable from carcinoma of the rectum or prostate is described.

[Primary primitive neuroectodermal tumor of the kidney in an adult. Clinico-pathologic and immunohistochemical case report]. / Primärer primitiver neuroektodermaler Tumor der Niere bei einem Erwachsenen. Klinisch pathologischer und immunhistochemischer Fallbericht.

We report a case of a primary renal primitive neuroectodermal tumour in a 24-year-old man associated with multiple pulmonary metastases. Histologically, the bulk of the kidney was replaced by a small round-cell tumour with numerous true Homer-Wright rosettes and perivascular pseudorosettes; wide-spread vascular invasion was noted. There was no evidence at autopsy of a primary tumour elsewhere. Immunohistochemically, the tumour cells stained strongly positive for O-13, a monoclonal antibody, which recognizes a recently described cell membrane glycoprotein (p30/32MIC2), more weakly for NSE and at least focally for PGP 9.5; the tumour did not stain for other neural markers, cytokeratin, leucocyte common antigen, or desmin. The differential diagnosis of small round-cell tumours in this location and the relation of primitive neuroectodermal tumours and Ewing's sarcoma are discussed.

Extracorporeal shock wave lithotripsy with the Storz Modulith SL20: the first 500 patients.

Our initial experience of extracorporeal shock wave lithotripsy (ESWL) with the Storz Modulith SL20 is reported. A total of 500 patients with 551 renal and 120 ureteric stones, mean diameter 11.9 mm, underwent 746 treatments; 68.2% of patients required a single treatment. The mean treatment rate for renal calculi was 1.4 and for ureteric calculi it was 1.5, rising to 4.2 for staghorns; 62.2% of treatments were performed on an out-patient basis. Analgesia (intravenous fentanyl) was required in 60.9% of treatments for renal calculi but in only 38.2% of those for ureteric calculi. The overall stone-free rate at 3 months was 77.6%, with a further 14.7% of patients having fragments less than 3 mm in diameter that required no further treatment. The stone-free rate was dependent on the site of the stone, with the majority of residual fragments lying in a lower pole calix. There were few complications. The Modulith is an efficient and safe lithotripter capable of treating stones in the kidney and throughout the ureter.

Ectopic prostatic glands in bulbar urethra. Immunoperoxidase study.

Ectopic prostatic glands in the bulbar urethra of a sixty-year-old man were identified by an indirect immunoperoxidase stain for prostatic acid phosphatase. Cystoscopically the appearances were those of "urethritis" without the polypoid appearance previously reported in cases of ectopic prostatic tissue.

Report on the first 1000 patients treated at St Thomas' Hospital by extracorporeal shockwave lithotripsy.

Since March 1985, over 1000 patients have been treated on the lithotripter at St Thomas' Hospital. Since it is the only machine in the country offering treatment to National Health Service patients at no cost to the referring Health Authority, there has been a heavy demand for treatment and 97% of referrals have been accepted. Analysis of the first 1000 patients shows extracorporeal shockwave lithotripsy (ESWL) to be a safe procedure with a low morbidity rate and no mortality. The number of patients who were stone-free 3 months after treatment was low (44.1%) compared with the numbers reported in other series. The most likely reasons for this are the poor follow-up rate (48.9%), the stringent criteria for the diagnosis of "stone-free" and a possible skewed referral and follow-up pattern.

Subtrigonal phenol injection therapy for incontinence in female patients with multiple sclerosis.

24 female patients with multiple sclerosis presented with severe urge incontinence or leakage around an indwelling urethral catheter. All had failed to respond satisfactorily to drug therapy. After subtrigonal phenol injection 83% were dry.

Isolated ileal loop augmentation of existing ileal conduit.

A new method of stomal revision in an existing ileal conduit is described. Two cases are reported in which the procedure was a success. It is suggested that ileal loop augmentation of an existing ileal loop may serve, in selected cases, as a useful alternative to complete conduit reconstruction.

Subtrigonal phenol injection for urge incontinence secondary to detrusor instability in females.

Thirty female patients with urge incontinence or bypassing an indwelling urethral catheter have been treated by subtrigonal phenol injection. All were proven to have detrusor instability. The injection method is described. Seventy-six per cent of patients were rendered dry. The urodynamic changes are recorded.

Intra-prostatic urinary reflux: an aetiological factor in abacterial prostatitis.

That urine might reflux into the prostatic ducts during micturition has never before been proved. Using a suspension of carbon particles it has been demonstrated that this can occur. It is suggested that this may be important both as a route of infection in bacterial prostatitis and as a cause of the inflammatory process in abacterial prostatitis.

Clinical experience with intravesical prostaglandin E2. A prospective study of 36 patients.

In a prospective study, intravesical prostaglandins were given to 36 patients who had urinary symptoms associated with a poorly functioning detrusor; 67% of these patients were found to be in chronic retention. Using standard urodynamic techniques, 72% showed objective evidence of an immediate improvement in detrusor function and there was prolonged therapeutic benefit in 39%. A prolonged response occurred only in patients who had an intact sacral reflex arc and urodynamic evidence of a pathologically enlarged bladder, and who did not have radiologically demonstrable outflow obstruction. The use of intravesical prostaglandin to stimulate the detrusor was also found to be of value as a urodynamic technique for the investigation of the lower urinary tract.

Stimulation of dorsal column in multiple sclerosis.

The effect of stimulating the dorsal column in 19 selected patients with multiple sclerosis was studied in detail over two weeks. Before and during stimulation the patients were examined clinically; videotape recordings made of their movements; psychomotor performance tested; electrolaryngography performed; and urodynamic studies carried out. Improvement was seen in walking speed, power in certain muscle groups, chronic pain, and bladder function. The motor improvement was thought to be related to the effects of high motivation and practice, and therefore to be of doubtful importance. The changes in bladder function were more convincing and justify further study.

Co-trimoxazole in prevention of bacteriuria after prostatectomy.

In a prospective, double-blind trial prophylactic cotrimoxazole produced a highly significant reduction in the incidence of bacteriuria after prostatectomy. Only two out of 38 patients who received the drug developed bacteriuria compared with 19 out of 36 patients on placebo. Klebsiella-Enterobacter spp and coagulase-negative staphylococci were responsible for most infections. Although co-trimoxazole prophylaxis is obviously effective, widespread use might increase the incidence of bacterial resistance.

Clinical and experimental studies on the action of prostaglandins and their synthesis inhibitors on detrusor muscle in vitro and in vivo.

Experiments on muscle strips have shown that prostaglandin is naturally produced by the detrusor, and acts to increase the tone and spontaneous activity. An intimate relation between acetylcholine and prostaglandin has been demonstrated. Therapeutic application of prostaglandins has been successful in the treatment of chronic retention in women.

Urinary tract infection following trans-rectal biopsy of the prostate.

An unacceptably high incidence of urinary tract infection was found in a retrospective survey of patients undergoing trans-rectal biopsy of the prostate. The incidence was considerably greater than that found in a prospective survey of bladder endoscopy alone. It is suggested that preoperative antibiotic prophylaxis might be worthwhile in this situation.