Location of stents in the left anterior descending coronary artery using three dimensionally acquired, two dimensionally displayed transthoracic echocardiography.

The location of left anterior descending arterial stents was documented in 10 of 13 patients using 3-dimensionally acquired, 2-dimensionally displayed transthoracic echocardiography. The echocardiographic appearance of stents was characterized, and the location of the proximal and mid-left anterior descending artery was objectively documented.

Major complications of silicone penile prosthesis: predisposing clinical situations.

Necrosis of the corpora cavernosa of the penis developed in 2 patients with diabetes mellitus complicated by significant vascular disease following insertion of a silicone penile prosthesis necessitating its removal. The surgical maneuvers thought to predispose to these complications will be considered.

Pyeloduodenal fistula.

Twenty-eight cases of pyeloduodenal fistula are reviewed from the standpoint of pathogenesis, clinical presentation, diagnosis, and management. Our review suggests the majority of these fistulas involved the right kidney and occurred as a result of chronic renal inflammatory disease. The fistulas are most effectively diagnosed with retrograde pyelography. The review suggests the best management of pyeloduodenal fistula is nephrectomy and primary closure of the duodenum.

Peliosis hepatis after long-term androgen therapy.

Peliosis hepatis is a recognized, but rare, complication of androgen replacement therapy. We herein report such a complication with necropsy study of the liver so involved.

Neurogenic fibrosarcoma following radiation therapy for seminoma.

We report a case of radiation-induced neurogenic fibrosarcoma that developed in a patient who received radiation therapy for seminoma. The sarcoma developed within the irradiated field after a latency period of nineteen years. Although the occurrence of a secondary neoplasm is unusual, this possibility should be included in the differential diagnosis of patients who present with tumor growth after a long interval following radiation therapy.

Misconceptions about posterior approach for renoureteral surgery.

Misconceptions about the posterior approach for renal and ureteral surgery are dispelled. A review of the pertinent lumbar anatomy and a few fine points of technique are emphasized. The advantages of easy access to the kidney, minimal postoperative pain, and absence of the occurrence of postoperative hernia warrant more frequent use of this procedure.

Transthoracic echocardiographic power motion tissue imaging of an intracardiac tumor that could not be seen with conventional transthoracic echocardiographic recordings.

Power motion imaging allows interrogation of low-velocity tissue. By means of power motion imaging with 2 different late-model echographs we identified an intra-atrial tumor that was undetectable on conventional transthoracic echocardiograms.

Case report: complete response of metastatic transitional cell carcinoma of the bladder with chemotherapy alone.

Transitional cell carcinoma of the bladder has remained to date basically a surgical disease with the addition of preoperative radiation therapy to increase survival. Chemotherapy for bladder cancer is administered either in an adjuvant setting or in patients with metastatic disease, most of whom have been treated already with cystectomy and/or radiation. We report a complete response at 54 months in a patient with clinical stage D2 and pathologic stage D1 carcinoma using cisplatin, doxorubicin and cyclophosphamide. The patient was treated with urinary diversion and chemotherapy alone, and no attempt was made to remove the primary lesion.

Epidermoid cysts of the testis: a report of three cases and an analysis of 141 cases from the world literature.

Epidermoid cysts of the testis are rare and represent about 1% of all testicular tumors. An analysis of 141 cases reported to date in the world literature, including the cases reported here, indicates that 50% of the lesions occur in the third decade and 86% between the second and fourth decade. The most common presentations are painless enlargement of the testis (41%) for an average period of 2.25 years or incidental detection during routine physical examination (33%). Clinically, a discrete testicular nodule can be palpated in the majority of the cases (76%). Pathologic findings are those of a squamous lined cyst containing keratin with absence of appendages or other elements. It is believed that, despite the benign nature of the lesion, they should be treated by orchiectomy so that a thorough pathologic examination can be done to establish a confident diagnosis. While some controversy exists about their source of origin, all the evidence, including the age, more common occurrence among whites, and the rare reported cases arising in cryptorchid testis points to a germ cell origin for these lesions. The epidermoid cyst should thus be recognized as another subtype in the category of germ cell tumors of the testis and perhaps the ovary.

Scrotal enlargement following inguinal herniorrhaphy: ultrasound evaluation.

Although sonography has become an established modality in the evaluation of acute and chronic scrotal abnormalities, its role in the post-herniorrhaphy patient with scrotal swelling has not yet been defined. We present 5 patients with immediate and delayed complications of herniorrhaphy in which sonography provided useful clinical information. Immediate complications included scrotal hematomas, scrotal wall and septal thickening, epididymitis, and testicular displacement. Delayed complications included an infected hydrocele demonstrating a fluid-debris level. The etiology of scrotal swelling in postherniorrhaphy patients can be determined with sonography.

Ureteral stricture: experience with 31 cases.

We reviewed the records of 31 patients treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureteroenteral anastomoses (23 per cent), open ureterolithotomy (19 per cent), ureteroscopy (19 per cent), other urological procedures (16 per cent), general surgical and gynecological procedures (13 per cent) and miscellaneous causes (7 per cent). Of the patients 24 were managed initially with antegrade or retrograde balloon dilation or stenting and favorable outcomes were achieved in 12 (50 per cent), with a mean followup of 13 months. Of the 12 patients who failed endourological management 6 subsequently underwent open repair with a 100 per cent success rate. The remaining 7 patients underwent an open operation as the initial management and successful results were achieved in 6. The over-all rate of successful management of ureteral stricture disease using endoscopic and open surgical techniques was 77 per cent. A total of 7 patients (23 per cent) failed attempts at intervention: 5 showed evidence of decreasing renal function and 2 required nephrectomy.

Human papillomavirus typing of penile condyloma.

Infection with human papillomavirus has been identified as a significant risk factor for the development of cervical neoplasia. Knowledge of the characteristics of infecting human papillomavirus in male patients is lacking. We studied 37 men who presented with genital condyloma to identify the clinical appearance of the lesion, histological features and human papillomavirus type as determined by deoxyribonucleic acid molecular hybridization analysis. Of the patients 32 had penile shaft condyloma: 23 noticed the lesion themselves and 9 presented because the partner had condyloma. An adequate amount of deoxyribonucleic acid was available for analysis in 26 men. Lesions were caused by human papillomavirus types 6, 11 and 31, and uncharacterized types. Five patients had penile shaft and urethral condyloma. In 4 patients infection was caused by more than 1 type or subtype. Neither clinical nor histological features could reliably predict the infecting human papillomavirus type.

Malacoplakia of the bladder: a case report of resolution with bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.

Malacoplakia is a granulomatous disease that most frequently involves the urinary tract but also may involve the genital tract, gastrointestinal tract and retroperitoneum. It is believed to be infectious in origin, secondary to a deficiency of intracellular lysosomal digestion, and heretofore considered a chronic problem. We report a case of malacoplakia of the bladder, which was treated successfully with a combination of bethanechol, trimethoprim-sulfamethoxazole and ascorbic acid.