The value of scrotal ultrasound in patients with suspected testicular tumour

A prospective study was designed to assess the value of scrotal ultrasound in the diagnosis of testicular neoplasm. Comparison of findings yielded by ultrasound with those made on surgical exploration of the scrotal contents in 56 patients showed a sensitivity of 94.6%, specificity of 57.9% and an overall accuracy of ultrasound of 82.1%. While capable of distinguishing intra-from extratesticular structure, scrotal ultrasound is not specific enough to differentiate a tumour from benign diseases involving testicular parenchyma. Still, it may add new information to the clinical examination of the scrotum, and reduce the number of probatory surgical procedures in patients with the finding of an intrascrotal mass. This paper describes the ultrasound pictures of a normal testis, testicular tumours and extratesticular disease that are most often considered in the differential diagnosis of testicular tumours.     

Comparison of three dosage regimens of ciprofloxacin in urinary tract infections

Fifty-four patients with complicated UTI were administered ciprofloxacin in doses of 500 mg (30 subjects) and 250 mg (24 subjects) at 12-hour intervals. While a positive effect was noted in 96–100% upon termination of therapy, the effect was still present 3 weeks later in 90% of the high-dose, but only in 71% of the low-dose group. In 23 patients with uncomplicated UTI, a positive effect of the three-day therapy with 100 mg of ciprofloxacin at 12-hour intervals was observed in 91% of subjects. Intolerance to the agent was found in one case only. Development of resistance to ciprofloxacin was not observed.     

Advantages of converting incontinent to continent urinary diversion

A modified Mainz pouch with catheterizable stoma was constructed in six patients who had originally undergone incontinent urinary diversion by ureteroileostomy 7 to 22 years previously for bladder exstrophy or neurogenic bladder with total urinary incontinence. The surgical technique differed from the standard as follows: after stomal excision, the preexisting ileal loop was detubularized and combined with additional ileal and colonic segments for pouch construction. In patients in whom the original ureteroileal anastomoses were patent and the contrast medium refluxed freely to the upper urinary tract during loopography, the ureters were not reimplanted but kept intact. In all patients the ileal valve was connected as stoma to the umbilicus. In addition, two patients underwent construction of a standard Mainz pouch. One had had primary ureterosigmoidostomy and the other one ureterostomies, 10 and 3 months previously, respectively. The urodynamic characteristics of the reservoir were normal in all. In six ureteropelvic units dilation improved significantly and in two patients the bilateral loop-ureter reflux diminished. Long-term follow-up (up to 45 months) showed no further impairment of the kidneys.     

The nicotinic acid test in the evaluation of unconjugated hyperbilirubinemia

In 42 young adults with Gilbert's syndrome and in 9 patients with inactive, well-compensated liver cirrhosis the peroral nicotinic acid test was performed. Of the 13 parameters tested, the groups differed significantly in the sum of total and unconjugated serum bilirubin concentrations, respectively, during the test; in the difference between the maximal and initial concentrations of total and unconjugated bilirubin; in the retention of total bilirubin at the third, fourth and fifth hour of the test; and in the size of the area under the curve of unconjugated bilirubin increase. However, due to considerable overlap, no single parameter could reliably differentiate among all persons with Gilbert's syndrome and cirrhotics. The nicotinic acid test is neither necessary for the diagnosis of Gilbert's syndrome nor can it reliably differentiate between this condition and severe organic liver disease. Yet, it does supply valuable information about the readiness of the organism to develop or enhance hyperbilirubinemia following a defined stimulus.     

A case of recurrent parotid swelling,syncope, arthritis and nephrotic syndrome

The differential diagnoses and histopathological findings of a case of recurrent parotid swelling, syncope, arthritis and nephrotic syndrome will be discussed. Primary Sjögren's syndrome is rarely associated with granulomatous inflammation, panniculitis and systemic amyloidosis. Multi‐organ failure, in particular cardiac amyloidosis, is potentially fatal.     

Natural killer cells and cytomegalovirus and Epstein-Barr virus infection in cardiac graft recipients

The serum of 10 male patients undergoing heart transplantation was found to contain anamnestic antibodies (IgG) against cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Patients with decreased natural killer (NK) cell activity displayed specific IgM against these viruses, a fact suggesting their activation and reproduction. Patients whose NK activity was within the range of that of healthy blood donors did not have serum IgM against CMV and EBV. Decreased NK activity and presence of specific IgM are associated with an increased number of LGL and monocytes, determined both by a monoclonal antibody (MEM-18) against their surface antigen, and morphologically.