Testicular leydig cell hyperplasia as a cause of familial sexual precocity.

Testicular Leydig cell hyperplasia was observed in two brothers presenting with progressive sexual precocity at 2 yr of age. Virilization was shown to result from increased secretion rather than decreased clearance of gonadal testosterone. Testosterone hypersecretion appeared to be gonadotropin independent, as basal and gonadotropin-releasing hormone-induced serum LH concentrations were low by both RIA and bioassay. Adrenal steroidogenesis was demonstrated to be normal by ACTH stimulation, dexamethasone suppression, and split adrenal venous function tests. Testicular histology revealed immature reproductive structures in the 2 yr old, but advanced spermatogenesis in the 3 yr-old brother. The etiology of both Leydig cell hyperplasia and reproductive testicular maturation in the absence of significant gonadotropin secretion remains to be established.

Protein kinase C regulates leukotriene B4 receptors in human neutrophils.

Three protein kinase C (PKC) activators, viz. phorbol myristate acetate, mezerein, and rac-1-O-myristoyl-2-acetylglycerol, inhibited human neutrophil binding of [3H] leukotriene B4 (LTB4) by reducing the number of high-affinity receptors available to the arachidonic acid metabolite. The inhibitory effect occurred in whole cells and cytoplasts but not in isolated membranes; it appeared to involve the activation of PKC rather than direct competition for binding sites. PKC may govern cellular responsiveness by regulating the receptor-linked bioactions of endogenous mediators like LTB4.

Acute unilateral adrenal hemorrhage following ACTH administration in a patient with Cushing's syndrome.

A patient with Cushing's syndrome and a concomitant unilateral adrenal hemorrhage following ACTH administration is described. Although stress is commonly associated with the onset of adrenal hemorrhage, a pathologically documented adrenal hemorrhage has not been previously in association with ACTH administration in Cushing's syndrome. Repeated doses of ACTH should not be given to patients with Cushing's syndrome as this has little diagnostic value and may lead to adrenal hemorrhage in such patients.

Ureteropelvic junction obstruction presenting with recurrent abdominal pain: diagnosis by ultrasound.

Three cases of ureteropelvic junction obstruction are presented in which the only symptom was recurrent abdominal pain. Results of physical examination and urinalysis were normal. Ultrasound established the correct diagnosis in the two patients in whom it was performed. Because it is safe, involves no radiation exposure, and is useful in evaluating the gallbladder, pancrease, and liver, as well as both kidneys, abdominal ultrasound should be performed prior to contrast radiography in the evaluation of children with recurrent abdominal pain.

Translocation (7;7)(p13;q21) in a Wilms' tumor.

Reports of single chromosome aberrations in Wilms' tumors are rare, with most tumors being characterized by multiple complex karyotype aberrations. An 11-month-old female patient with Wilms' tumor and a derivative chromosome 7 resulting from t(7;7)(p13;q21) as the sole cytogenetic aberration is described.

Effect of urinary extravasation on renal wound healing in dogs.

It is frequently stated that extravasation of urine after intrarenal surgery is deleterious to renal wound healing causing fibrosis or granulation tissue. A study using dogs was designed to test the hypothesis that the contact of urine with incised renal parenchyma may cause altered wound healing. This study showed that exposure of the renal parenchyma to extravasated urine from open collecting structures did not alter renal healing.

Rare penile anomalies presenting with complication of circumcision.

Two rare penile anomalies, scaphoid megalourethra and 180-degree torsion of the penis, which presented as complications of circumcision are reported. Complications of circumcision of this type may be prevented by careful inspection of the penis prior to circumcision, by delaying circumcision if a penile abnormality is noted, and by careful visualization during all aspects of the procedure.

Histologic study of kidneys drained by short ileal conduits in dogs.

The ileal conduit with a refluxing ureteroileal anastomosis is considered by many to be a factor in the development of pyelonephritis and renal deterioration in patients so diverted. This opinion is supported by previous experimental work utilizing dogs. A histologic study of dog kidneys drained by a short ileal conduit is presented which shows an incidence of pyelonephritis of 17.6 per cent. Pyelonephritis occurred only when obstruction was present.

Extensive shortening of ileal conduit through peristomal incision.

A conservative procedure is described for shortening the redundant ileal segment through a peristomal incision. The procedure may be used to complement a stomal revision.

Observations on course of cremasteric muscle in perineal testes with commentary on gubernaculum.

Three instances of perineal testes are described including the fourth reported case of bilateral perineal testes. In each instance the course of the cremasteric muscle was traced distally and was found to terminate in the perineum. It is suggested that if the cremasteric muscle forms in the periphery of the gubernaculum, then the cremasteric muscle should be indicative of the course and the termination of the gubernaculum.

Results of undiverted simple closure of 51 urethrocutaneous fistulas in boys.

Urethral fistulas are an inherent risk of hypospadias repair. Present-day repairs of hypospadias in which redundant skin is held to a minimum limit the applicability of skin flap advancement technique for closure. To avoid altering the cosmesis of the prior hypospadias repair, 51 urethrocutaneous fistulas were closed using a three-layer simple closure technique without urinary diversion. An 80 percent success rate was achieved following the initial closure. A second simple closure of those which failed also succeeded in 80 percent of the cases.

Instrument to facilitate nephrostomy.

An instrument to facilitate the placement of a nephrostomy tube is described. The techniques for performing nephrostomies are historically reviewed.

Bilateral cysts of tunica albuginea of testes.

A case is presented of a patient with bilateral cysts of the tunica albuginea. An orchiectomy had been accomplished on the right side, with confirmation of cysts of the tunica albuginea. Cysts of the contralateral testicle were diagnosed by testicular ultrasound examination. This case represents the first reported instance of bilateral cysts of the tunica albuginea.

Massive post-ejaculation hematuria.

The case of a twenty-nine-year-old white male with massive post-ejaculation hematuria, an entity distinct from hemospermia, is described. The site of bleeding was found to be large varicosities located at the apex of the prostate. Fulguration of the veins produced complete resolution of the bleeding.

Neonatal genital trauma.

A neonate with severe scrotal ecchymosis resulting from a breech delivery is presented. The incidence, potential complications, and management are discussed.

Accessory perineal scrotum.

A sixth case of a patient with an accessory perineal scrotum is presented.

Hereditary nephritis associated with vesicoureteral reflux and vaginal duplication.

The concomitant occurrence of vesicoureteral reflux and hereditary nephritis has not been previously reported. A case of a patient with hereditary nephritis, vesicoureteral reflux, and vaginal duplication is presented and the related literature reviewed. It is suggested that familial reflux may occur significantly in families with hereditary nephritis.

Microscopic pulmonary embolization by adenocarcinoma of prostate.

Microscopic tumor embolization is an uncommon cause of respiratory insufficiency. This finding has been reported previously in only 2 patients with carcinoma of the prostate. The diagnosis should be suspected in a patient with cancer of the prostate who was unexplained dyspnea or respiratory failure. Treatment consists of either bilateral orchiectomy or hormonal therapy. A case is reported of adenocarcinoma of the prostate with widespread microscopic pulmonary embolization causing respiratory failure.

Torsion of vermiform appendix: cause of acutely painful scrotum.

An unusual case is reported of a two-month-old infant who presented with an acutely painful swollen scrotum which at exploration was found to be secondary to a torsion of the tip of the vermiform appendix.

Ureteral obstruction secondary to iliac artery aneurysm.

A patient with an unusual unilateral ureteral obstruction secondary to mechanical obstruction by a common iliac artery aneurysm in association with an abdominal-aortic aneurysm is presented. A diagnosis of ureteral obstruction should be suspected in a patient with flank or abdominal pain and an infra-umbilical (iliac) aneurysm. Treatment is directed toward the aneurysm. The aneurysmal wall attachments to the ureter should be left undisturbed.