The erect penis--injury prone organ

Erection converts the safe, flaccid penis into a vulnerable organ. During erection, the usually thick tunica albuginea becomes very thin and easily fracturable. Penile fracture is an under-reported urologic injury, with only approximately 100 cases reported in the world literature. We report on three cases, one with rupture of one corpus spongiosum and two with rupture of both corpora cavernosa associated with almost complete transection of the urethra. All three cases were treated surgically, with good outcome and no postoperative complications. The authors postulate that some cases of deviation of the penis are actually the result of some minor degree of penile fracture.     

Relationship between peroxisome proliferator‐activated receptor alpha activity and cellular concentration of 14 perfluoroalkyl substances in HepG2 cells

Peroxisome proliferator‐activated receptor alpha (PPARα) is a molecular target for perfluoroalkyl substances (PFASs). Little is known about the cellular uptake of PFASs and how it affects the PPARα activity. We investigated the relationship between PPARα activity and cellular concentration in HepG2 cells of 14 PFASs, including perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates and perfluorooctane sulfonamide (FOSA). Cellular concentrations were determined by high‐performance liquid chromatography–tandem mass spectrometry and PPARα activity was determined in transiently transfected cells by reporter gene assay. Cellular uptake of the PFASs was low (0.04–4.1%) with absolute cellular concentrations in the range 4–2500 ng mg^?1 protein. Cellular concentration of PFCAs increased with perfluorocarbon chain length up to perfluorododecanoate. PPARα activity of PFCAs increased with chain length up to perfluorooctanoate. The maximum induction of PPARα activity was similar for short‐chain (perfluorobutanoate and perfluoropentanoate) and long‐chain PFCAs (perfluorododecanoate and perfluorotetradecanoate) (approximately twofold). However, PPARα activities were induced at lower cellular concentrations for the short‐chain homologs compared to the long‐chain homologs. Perfluorohexanoate, perfluoroheptanoate, perfluorooctanoate, perfluorononanoate (PFNA) and perfluorodecanoate induced PPARα activities >2.5‐fold compared to controls. The concentration–response relationships were positive for all the tested compounds, except perfluorooctane sulfonate PFOS and FOSA, and were compound‐specific, as demonstrated by differences in the estimated slopes. The relationships were steeper for PFCAs with chain lengths up to and including PFNA than for the other studied PFASs. To our knowledge, this is the first report establishing relationships between PPARα activity and cellular concentration of a broad range of PFASs.     

Incisional self-administration of bupivacaine or ropivacaine provides effective analgesia after inguinal hernia repair

PURPOSE: To evaluate the safety and applicability of two local anesthetic (LA) solutions self-administered for pain treatment after inguinal hernia repair (IHR) by balloon-pumps via catheters placed in the surgical wound. Effectiveness of analgesia was also compared. METHODS: Two groups of patients for IHR were included in the randomized, double-blind study. An epidural catheter was placed in the surgical wound, tunneled subcutaneously and connected to a balloon-pump containing either 0.25% bupivacaine (B) or 0.25% ropivacaine (R). Postoperatively, the patient self-administered the LA into the wound. Administration could be repeated after 20 min. If moderate to severe pain still persisted, rescue medication (piritramid) was given intravenously. The variables recorded in both groups were: visual analogue scale (VAS), pain scores at rest and with movement, number of applications, wound healing, patients' satisfaction. RESULTS: During the first 24 hr, median number of LA applications in 26 B patients was 4 (range 1-6) and in 25 R patients 3 (range 1-5). Both groups showed low VAS pain scores: less than 2 at rest, less than 4 with movement. Eighty percent of patients of each group would choose this type of analgesia again. Two patients from B Group and three from R Group needed rescue medication. No wound infection was observed. There were no statistically significant differences between the groups. CONCLUSION: Self-administration of the LA solution via a catheter in the surgical wound is an effective method of pain relief after IHR with little side-effects.     

Malignant Sertoli cell tumor of testicle

The eleventh case of malignant Sertoli cell tumor of the testicle is described. The tumor displayed malignant character with local invasion into the epididymis. Retroperitoneal lymph node dissection revealed a malignant deposit around the left renal artery.     

Renal pedicle injury in the multiple injured patient

Renal pedicle injuries were associated with multiple system trauma and a mortality rate of 42 per cent in 31 patients seen from 1959 to 1978. These injuries were to the renal artery in 14 patients, branches of the renal artery in 5, renal vein in 8, and renal artery and vein in 4. Priority of treatment for life-threatening associated injuries resulted in delayed diagnosis of the renal pedicle injury, which was not optimal for preservation of functioning renal tissues. Since 1968 an immediate excretory urogram has been performed for hematuria or a perirenal hematoma found during laparotomy for associated injuries. This study has resulted in the early diagnosis of renal pedicle injuries and immediate vascular repair has been attempted in 6 patients. Three of these patients survived with no hypertension on followup. A repaired renal vein in 1 patinet resulted in normal renal function and renal arteries were repaired in the other 2 patients with reduced renal function.