Pulmonary embolism from left subclavian vein thrombus following suprapubic prostatectomy.

Deep venous thrombosis (DVT) of the axillary and subclavian veins accounts for approximately 1-2 percent of all recorded deep venous thrombosis. Pulmonary embolism from an upper extremity DVT has been reported to vary between 2 percent and 35.7 percent. We report the occurrence of a left subclavian vein DVT with subsequent nonfatal pulmonary embolism in a sixty-two-year-old patient twenty-four hours following suprapubic prostatectomy. A review of the literature is presented, along with pathophysiology, diagnosis, and treatment.

Nondetectable prostate-specific antigen in moderately differentiated adenocarcinoma of prostate.

Prostate-specific antigen (PSA) is a glycoprotein derived from prostatic ductal and acinar epithelial cells. The main clinical use of PSA is as a marker of prostate tumor progression/recurrence. We present a case of a sixty-nine-year-old patient with recurrent endometrioid carcinoma of the prostate (status post-radical prostatectomy, hormonal therapy, and external beam radiation therapy) with normal serum PSA.

Cyclophosphamide-associated carcinoma of urothelium: modalities for prevention.

The relationship between the cyclophosphamide metabolite acrolein and hemorrhagic cystitis is well documented. Its role in inducing bladder cancer is not clear. There are at least 35 cases of cyclophosphamide-associated bladder cancer in the literature to date. We report 3 additional cases of transitional cell carcinoma of the bladder. Literature assessing the relative risk of bladder cancer associated with cyclophosphamide therapy is reviewed as are methods for decreasing the toxic effects on the urothelium of the metabolite acrolein.

Bacillus Calmette-Guerin and interleukin-2 for treatment of superficial bladder cancer.

A total of 22 patients with bladder cancer received bacillus Calmette-Guerin (BCG) and interleukin-2. Significant bladder tumor remissions were noted in 15 of 17 patients (88%). Of 5 patients with carcinoma in situ 1 was noncompliant and he died of carcinoma in situ. The other 4 patients are in remission. BCG alone was instilled in 22 additional patients with superficial bladder cancer. The remission rates were encouraging. Of the 22 patients 13 (59%) had remission of the bladder tumor. A half dose of BCG (60 mg.) is adequate when given weekly for 6 weeks. Maintenance therapy is important as noted in both of our clinical arms. BCG and interleukin-2 therapy results in a higher remission rate.

Ioxilan, a third generation low osmolality nonionic contrast medium. Systemic and renal hemodynamic effects.

The choice between high cost, low toxicity nonionic contrast media (CM) and low cost ionic CM poses a dilemma for radiologists. Ioxilan, a third generation nonionic CM, is obtained by simple conversion from an ionic CM. To examine how this economically promising, low osmolality CM (570 mOsm at 300 mgI/ml) affects canine systemic and renal hemodynamics, IV bolus injections of 350 mgI/ml at 2 ml/kg of Iohexol and Ioxilan were compared. Satisfactory nephrograms and pyelograms were produced by both agents, without significant differences. The effects on systemic and renal hemodynamics were minimal and statistically equal for both CM. The acute systemic and renal responses and radiographic image quality of Ioxilan and Iohexol confirm that the two compounds are biologically equivalent, and that the novel molecular design employed in Ioxilan to achieve very low osmolality also provides good biological tolerance.

Human papillomavirus type 6 in grade I transitional cell carcinoma of the urethra.

Of 4 patients who underwent cystourethroscopy, biopsy and laser excision of suspected urethral condylomata acuminata 3 had coexistent grade I papillary transitional cell carcinoma of the urethra. Human papillomavirus type 6 messenger ribonucleic acid was demonstrated within biopsy specimens using tritium-labeled single-stranded antisense ribonucleic acid probes. Compared to condylomata the papillary transitional epithelium expressed less viral message, which might be expected in an epithelium that does not show full squamous epithelial or koilocytotic differentiation. Among these patients there was 1 papillary transitional lesion in the bladder that, although histologically similar, did not express human papillomavirus message, suggesting differential susceptibility of epithelium between the bladder and urethra. The finding of active human papillomavirus transcription within the urethral papillary transitional lesions raises the possibility of an active role for the virus in the pathogenesis of these lesions. These findings broaden the spectrum of epithelial types reported to support human papillomaviruses and provides impetus for a wider search for these viruses in other transitional cell neoplasms.

Repeat selective embolization of solitary kidney with renal cell carcinoma: case report.

Massive bleeding in a patient with metastatic carcinoma of a solitary kidney may be controlled with transcatheter embolization. Selective occlusion may be done sparing renal parenchyma uninvolved by tumor and avoiding dialysis. We report a case of successful repeated selective embolizations with an excellent quality of life for 18 months.

Effects of the magnetic resonance contrast medium ferrioxamine methanesulfonate on systemic and renal hemodynamics in the anesthetized dog.

Ferrioxamine methanesulfonate (S-FDF) is a new magnetic resonance (MR) contrast agent developed to improve magnetic resonance imaging of the abdomen and pelvis. This stable complex of deferoxamine methanesulfonate and iron is excreted in the urine by glomerular filtration modified by active renal tubular resorption. This study examines the acute systemic and renal hemodynamic responses to this agent after intravenous administration either as an infusion of 25 mg/kg over 5 minutes or as a rapid bolus at a dose of 50 mg/kg. In eight anesthetized dogs, renal plasma flow (RPF) was measured with an electromagnetic flowmeter, and GFR was determined by the renal extraction of technetium-99m-DTPA. Mean arterial pressure (MAP), pulse rate, and a lead II ECG were assessed. At a dose of 25 mg/kg over 5 minutes, MAP decreased significantly (control 146.0 +/- 6.5 mm Hg vs. 107 +/- 18 mm Hg at 2 minutes; P less than .05). In two of the eight animals, the MAP dropped below 60 mm Hg. Significant decreases in GFR and RPF also were noted. All four of the animals receiving the rapid injection of S-FDF experienced profound hypotension (MAP less than 50 mm Hg). The drop in heart rate from 152 +/- 11.6 bpm to 121 +/- 4.9 bpm was associated with a marked depression of the ST wave in the lead II ECG. Further animal studies are needed to assess the mechanism of toxicity and a potential synergism of action with pentobarbital anesthesia.

ND: YAG nomogram dosimetry scale for the bladder.

Bowel perforation and damage to surrounding organs is probably the most significant risk with the use of Nd-YAG laser in the bladder. To prevent this unwanted damage, a nomogram dosimetry scale was developed by delivering different settings of laser energy via a cystoscope to 25 female pigs. One week following treatment, exploratory laparotomy and cystectomy were performed. Microscopic analysis of the depth of laser irradiation was accomplished. From this study it was learned that, although the greater the energy delivered, the deeper the tissue damage, this is not uniform. Pulsed energy produced a deeper effect than continuous energy. The use of 30 watts of either pulsed or continuous energy for no longer than 15 seconds (450 joules) or 10 watts of either form of energy for less than 30 seconds (300 joules) did not produce bowel perforation. Other different combinations of high number of watts or pulses translated into transmural necrosis of the bladder with or without perforation and with or without bowel injury. Other factors such as density, thickness, color and temperature of tissue, type and wave length of laser and optimal focusing played a significant role in the final outcome. Useful information for human clinical use may be extrapolated from this experimental model.

Recovery of glomerular and tubular function in autotransplanted dog kidneys preserved by hypothermic storage or machine perfusion. Relation of initial function to long-term function.

Sixteen male dogs had split renal function studies prior to unilateral nephrectomy and autotransplant. Kidneys were preserved for 24 hr by either simple hypothermic storage in Collins C2 solution (SHS) or machine-perfused (MP) on a Waters machine (MOX 100) with plasmanate perfusate. Renal function studies were repeated at 1 hr and at 7, 14, and 28 days, and the statistical relationship between initial and 1-month function was determined for a number of parameters. All MP kidneys functioned immediately, whereas 1/3 of SHS kidneys had delayed function. Recovery was more rapid in MP kidneys and was essentially complete by 14 days, at which time MP kidneys had higher rates of creatinine clearance and sodium reabsorption. However, by one month 3/7 MP kidneys (P = 0.15 compared with SHS) had lower creatinine clearance rates than at 2 weeks, and para-aminohippurate (PAH) clearance and fractional sodium reabsorption were significantly decreased. During the same period SHS kidneys either showed continued improvement or maintained stable function. Thus, by one month there were no differences between the groups in clearances of creatinine and PAH, plasma creatinine and blood urea nitrogen concentrations, or fractional reabsorption of sodium, potassium, and water. For SHS kidneys, the 1-hr creatinine clearance and the absolute rate of sodium reabsorption were strong predictors of the eventual function of the kidneys at one month (r = 0.93 and r = .83, P less than 0.05, respectively). No such correlations were found in MP kidneys (r = less than .01, P greater than 0.9 for both variables). The data show that MP results in significantly better function early after transplant, but this advantage does not persist, and that SHS kidneys early function is a good predictor of long-term recovery, but this is not true for MP kidneys.

External ureteroneocystostomy in renal transplantation.

The urologic complications of 184 consecutive renal transplants (68 living-related and 116 cadaveric) performed at Walter Reed Army Medical Center are reviewed. An anterior extravesical technique modified from Witzel, Sampson, and Lich was used to reimplant the ureter. Urologic complications occurred in 11 patients (6%): urine leak (4), obstruction (3), stricture (3), and total ureteral necrosis (1). These complications occurred in the first 115 patients; no complications have been documented in the last 69 patients. The several advantages of extravesical ureteroneocystostomy include: less operative time, avoidance of a separate cystotomy, virtually no hematuria, ability to use short ureters, no need for splints or stents, shortened Foley catheter drainage, and no interference with native ureteral function. Complications are few and become uncommon with practice.

Penile tourniquet injury due to a coil of hair.

Penile strangulation caused by a coil of hair frequently is an unrecognized clinical entity with severe potential complications, such as urethrocutaneous fistulas, necrosis of the glans and partial or complete amputation of the glans. We report on a 7-year-old boy with a tourniquet injury to the penis secondary to a strand of hair.

Primary non-Hodgkin lymphoma of prostate presenting as benign prostatic hyperplasia.

A case of primary non-Hodgkin lymphoma of the prostatic gland is reported. The patient presented with a classic picture of benign prostatic hyperplasia. Review of the literature disclosed about 300 reported cases. Much controversy and confusion exists in the classification of non-Hodgkin lymphoma. The two current classifications are presented, and management of this condition is reviewed.