Recurrent dedifferentiated paratesticular liposarcoma with synchronous renal cell carcinoma and prostate cancer.

Paratesticular liposarcoma is a very rare cause of scrotal mass. It is thought that they arise from spermatic cord lipomas most commonly. While well differentiated tumors tend to share many histological similarities with dedifferentiated tumors, the latter has a much more aggressive phenotype. We present an unusual case of a 69-year-old male with synchronous prostate adenocarcinoma and unilateral renal cell carcinoma who was found to have a dedifferentiated paratesticular liposarcoma. Treatment was with radical resection, preserving the testis, followed by radiotherapy. Unusually recurrence did not occur until 4 years following initial treatment. This case demonstrates the high propensity of dedifferentiated liposarcoma to recur locally and examines the most frequently employed management strategies.

Recombinant activated factor VII to control life-threatening haemorrhagic radiation cystitis.

INTRODUCTION: The use of recombinant activated factor VII has been described for many clinical scenarios, but the value of this therapeutic agent for life-threatening haemorrhagic cystitis remains novel. METHOD: We describe a case of persistent life-threatening haemorrhagic radiation cystitis, and discuss current knowledge of this therapy including potential complications. RESULT: Control of haemorrhage was successfully achieved only after use of this agent. CONCLUSION: This therapy deserves mention in any future management algorithm devised for this condition.

Renal trauma in the west of Ireland--a regional review.

We herein present a regional review of the management of renal trauma in the west of Ireland. The majority of renal injuries occur as a result of blunt trauma and are amenable to conservative management. We sought to streamline the management of renal trauma in the west of Ireland. With the current restructuring of the Irish Health Service, it is important to acknowledge the role of the urologist in the management of trauma patients.

Exploration of the acute scrotum: a retrospective analysis of 100 consecutive cases.

BACKGROUND: Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, as no investigation can confidently exclude torsion of testis from the differential diagnoses. In our department, all patients up to the age of 40 years, presenting with acute scrotal pain undergo emergency scrotal exploration. AIM: This study assesses the outcome of such a policy in one unit. METHODS: The notes of 100 consecutive males who underwent exploration of scrotum have been reviewed. RESULTS: Testicular torsion was diagnosed in 33% of patients, with torsion of the appendix testis being the next most common entity. In the group with testicular torsion 12% required orchidectomy, and all had presented at least 24 hours after the onset of pain. The perioperative morbidity of scrotal exploration was very low. CONCLUSION: These data justify the policy of emergency exploration for all cases of acute scrotal pain up to the age of 40 years.

Effect of altering the daily herbage allowance to cows in mid lactation on the composition, ripening and functionality of low-moisture, part-skim Mozzarella cheese.

Milk was collected from three spring-calving herds, on different daily herbage allowances (DHA) of perennial rye-grass (16, 20 or 24 kg dry matter (DM)/cow for a 17 week period. On five occasions, at weekly intervals in the middle of the period, the three different milks were converted into low-moisture part-skim Mozzarella cheese. Increasing the DHA resulted in significant increases in the concentrations of protein in the cheesemilk (P < 0.05) and cheese whey (P < 0.02). The moisture-adjusted cheese yield increased significantly (P < 0.01) on raising the DHA from 16 to 24 kg grass DM/cow. DHA had no significant effects on any of the gross compositional values of the cheese (although moisture and fat-in-DM levels tended to decrease and increase respectively with increasing DHA). The hardness of the uncooked cheese and functionality of cooked cheese (i.e. melt time, flowability, stretch and viscosity) were not significantly influenced by DHA over the 115 d ripening period at 4 degrees C.

Effects of preoperative methoxamine on blood loss and haemodynamic variables during transurethral prostatic resection under spinal anaesthesia.

Thirty-six patients who presented for transurethral prostatic resection were allocated randomly to one of two groups. Patients in group A were given methoxamine 10 mg i.m., 15 min before spinal anaesthesia. Patients in group B acted as a control group. All patients received spinal anaesthesia. Preoperative administration of methoxamine 10 mg i.m. decreased blood loss significantly and improved haemodynamic stability compared with the control group.

Prazosin in the treatment of prostatic obstruction. A placebo-controlled study.

Eighty patients with prostatic obstruction were entered into a double-blind parallel study of prazosin versus placebo. There were 25 withdrawals or exclusions, leaving 55 patients for analysis. Mean maximum flow rates increased significantly more in patients treated with prazosin than in those treated with placebo (P less than 0.005), but there was no significant reduction in maximum voiding pressure. The mean number of voids, recorded on diary cards, was reduced from an initial 10.0/24 h by 2.1 in the final week, a significantly greater reduction than in the placebo group (P less than 0.01). However, there were no statistically significant changes in the filling cystometrograms. When patients were classified as responders or non-responders in terms of bladder filling, urine flow, bladder emptying, weekly average of voids/24 h and nocturia, the proportion of patients responding to prazosin was significantly greater in all categories except bladder filling and emptying. It was concluded that prazosin at a dose of 2 mg bd is a safe and effective treatment for prostatic obstruction and may be used in patients awaiting surgery and those who are unfit for operation.

Invasive bladder cancer treated by radical external radiotherapy.

Fifty-three consecutive, unselected patients with invasive bladder cancer, Stage T2 to T3, treated by radical radiotherapy have been reviewed. Cystectomy was reserved for patients with significant worsening of disease during treatment, histologically confirmed persistent or recurrent invasive tumour after treatment, or patients with intolerable symptoms due to radiation cystitis. In 64% of our patients a favourable tumour response to radiotherapy was seen, while a further 31% showed disease progression either during or on completion of radiotherapy. Cystectomy was performed on 22% of patients, mainly for radiation cystitis, and was not associated with a significant operative mortality rate. The crude 5-year survival rate was 42%. We conclude that radical radiotherapy is as effective as other forms of treatment for invasive bladder cancer, but that there remains a need to identify those bladder tumours destined to respond poorly to radiotherapy at an earlier stage.

Radical surgery following radiotherapy for advanced parotid carcinoma.

We have reviewed the surgical treatment of 12 consecutive patients with advanced carcinoma of the parotid gland at this hospital. Ten patients received immediate preoperative radiotherapy to a mean total dose (TD) of 4000 cGy (rad), range 2600-6500 cGy. Two patients with recurrent carcinoma had previously been treated with local radiotherapy (TD 6500 cGy) at 1 year and 2 years respectively prior to referral. A radical parotidectomy with block dissection of the neck was performed on all 12 patients. After a follow-up period ranging from 6 months to 8 years, 6 patients have remained disease free including 3 patients who have died from unrelated causes within this period. Three patients have developed local recurrent disease (interval 9 months-3 years), 3 further patients with residual microscopic disease have been observed postoperatively (follow-up interval 6 months-2 years) without developing overt local recurrence.

The value of parotid sialography.

One hundred consecutive parotid sialograms were reviewed to assess the clinical usefulness of the technique. In 54 per cent of patients significant information was provided by the sialogram, and in 22 per cent the diagnosis was made on sialographic appearances alone or the findings altered subsequent management. The highest proportion of useful investigations was found in those presenting with bilateral parotid swelling. No significant information was obtained in patients with an isolated lump in the parotid region.