A clinically applicable method to preserve urine and bladder washing cells for flow cytometric monitoring of bladder cancer patients

We describe a method to fix exfoliated bladder cells that is suitable for followup of bladder cancer patients by deoxyribonucleic acid flow cytometry. After fixation with room temperature methanol plus acetic acid (20:1, volume:volume) urine and bladder washing samples from these patients can be stored at room temperature for 3 to 7 days and then assessed reliably for the presence of aneuploidy and the percentage of hyperdiploid cells. For those with active transitional cell carcinoma diagnostic accuracy comparing fresh to fixed specimens was improved from 58 to 92% with urine and from 50 to 100% with washing samples. For patients with a history of transitional cell carcinoma who currently are free of disease the false positive rate remains unchanged after fixation. The procedure described is suitable for use in the outpatient clinic and should permit shipping of samples without refrigeration to a central flow cytometry facility for analysis.     

Medical Kits For Business Travellers

A survey of occupational physicians of the Food Industry MedicalOfficers Group was undertaken to establish details of medicalkits supplied by their organizations to business travellers.The most common approach was an in-house medical kit with instructionsemphasizing self treatment of the common ailments of travellerssuch as motion sickness, sleeplessness, diarrhoea, indigestionand headaches. The majority of kits included a small supplyof needles, syringes, IV cannulae etc either in a commercial‘;Aids Kit’ or as inhouse supplies. Antimalarialswere provided either as a standard kit item or as required.About half provided antibiotics for the self treatment of infections.Very few provided a telephone number for use in the event ofmedical emergencies. A standard medical kit specification isproposed. Requests for reprints should be addressed to: Dr S.P. Deacon, Corporate Health and Safety, Kellogg Company of GB Ltd, Stretford, Manchester M32 8RA. U.K.     

Prospective comparative study of cefotetan with piperacillin for prophylaxis against infection in elective colorectal surgery

This study compared one dose of cefotetan with three doses of piperacillin as prophylaxis against wound infection in 153 patients undergoing elective colorectal surgery. The patients were randomized into two groups: the first received 2 g cefotetan intravenously with induction of anaesthesia (n = 75), and the second received three doses of 2 g piperacillin (n = 78). Wound infection was defined as the presence of an abscess or discharging pus from the wound. In the cefotetan group there were 14 (19%) wound infections and 13 (17%) in the piperacillin group. There were three septic deaths, one in the cefotetan group and two in the piperacillin group. Both groups were comparable with regard to age, sex, nature of pathology and pre- and perioperative risk factors. No significant haematological or biochemical abnormalities were detected. The only adverse reaction was one patient who had an allergic reaction (rash) to piperacillin. These data suggest that single-dose cefotetan is as effective as triple-dose piperacillin in prophylaxis against infection in elective colorectal surgery.     

Branched, struvite calculus and clear cell carcinoma in same kidney. Rare condition with significant implications for management

The concomitant existence of a branched (partial staghorn) calculus and clear cell carcinoma (hypernephroma) in the same kidney is rare. Herein, we report the eighth such case in the world literature, and to our knowledge, the first patient with a parenchymal tumor identified preoperatively. In all of the previous 7 cases, the calculus was managed with open renal exploration, and only at the time of surgery was the incidental renal cell carcinoma identified; the surgical procedure was modified accordingly. With open surgery no longer the cornerstone of therapy for renal calculi, it is imperative that the kidney be evaluated in a meticulous and compulsive manner prior to extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PNL). The finding of a coexisting renal cell carcinoma will radically alter the patient's treatment.     

The worldwide problem of methicillin-resistant Staphylococcus aureus

Strains of Staphylococcus aureus resistant to both methicillin and aminoglycosides (e.g. gentamicin) emerged during the late 1970s. They have now become established in hospitals throughout the world, and outbreaks of infection and colonization cause severe clinical and managerial problems. Therapeutic options are limited and clearance of the carrier state may be difficult. Much is known about the genetic and biochemical properties of the organisms but more work is necessary both to develop antibiotics active against these strains and to formulate effective measures for their control.     

Arthroscopy in diagnosis and treatment of traumatic and nontraumatic disorders of the knee joint]

A series of 325 diagnostic and operative arthroscopic procedures were reviewed--the growing importance of this technique was underlined. An open meniscectomy was performed in 235 cases after diagnostic arthroscopy. In 45 cases meniscal flap was removed arthroscopically. In 7 cases chondral or osteochondral loose bodies were removed, in 5 cases the hypertrophic synovial fold was cut, in 3 cases staples or fixation screws were removed and 3 diagnostic biopsies were carried out. No significant complication was observed. It was stated that arthroscopy makes diagnostics more precise, enables performing some operations without opening that joint, reduces of treatment and its costs.     

Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts.

The first superior vena cava-pulmonary artery shunt (Glenn shunt) in our series was performed in February 1958. From then through September 1988, 91 patients have undergone this procedure for a wide variety of congenital defects. We here report follow-up data available on all patients. Ages ranged from 2 days to 46 years (mean 6.8). Diagnoses were as follows: tricuspid atresia, 27; single ventricle, 22; tetralogy of Fallot, 14; D-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis, 9; D-transposition, 5; Ebstein's anomaly, 4; pulmonary atresia + intact septum, 4; and others, 6. The hospital mortality rate was 7.7% (one death in the last 53 patients, 1.9%). Five deaths occurred in patients less than 6 months old. There were 20 late deaths (22%) with actuarial survival rates of 84% and 66% at 10 and 20 years, respectively. Pulmonary arteriovenous fistula formation was seen in 18 patients (19.7%), six of whom have undergone therapeutic embolization with improvement in saturation. The prevalence of pulmonary arteriovenous fistula increases with time after shunt. No long-term shunt thrombosis or stricture formation was seen. Fifty percent of shunts were still functioning at 20 years. Palliation was limited because of decrease in blood flow to the contralateral pulmonary artery, collaterals between the inferior and superior venae cavae, and pulmonary arteriovenous fistula formation. Improvement in saturation was obtained in eight otherwise inoperable patients by creation of a right axillary arteriovenous fistula up to 19 years after the Glenn shunt. Three patients had conversion of a Blalock-Taussig shunt to a Glenn shunt with improvement in congestive heart failure. Twenty-six patients have undergone a Fontan procedure with two deaths. Compared with the group having a Fontan procedure without a prior Glenn operation, there was no difference in early or late mortality. Thirty years after a Glenn shunt, the first patient in this series is working full time after having undergone a modified Fontan procedure in 1981. We conclude that the Glenn connection, usually with supplemental procedures to enhance oxygenation, has provided excellent physiologic palliation with low mortality up to 30 years with no late thrombosis or stricture formation. The incidence of pulmonary arteriovenous fistula increases with time and can be effectively treated with embolization. Physiologic repair after the Glenn shunt carries a low mortality. Although currently used infrequently, superior vena cava-pulmonary artery shunting remains a useful method of palliation in selected patients.(ABSTRACT TRUNCATED AT 400 WORDS)     

Percutaneous nephrostomy drainage in the management of neonatal anuria secondary to renal candidiasis

We report a case of anuria in a premature neonate secondary to bilateral ureteropelvic junction obstructions related to Candida bezoars. Percutaneous decompression and drainage of both kidneys contributed significantly to the successful management of renal candidiasis in this patient. A review of the literature is presented.     

Malignant peripheral neuroectodermal tumors in urology

Summary During the past few years, a new tumor type has emerged in the pediatric and adolescent group of cancer patients, which has been designated malignant peripheral neuroectodermal tumor (MPNT). This tumor has some clinical and pathological signs in common with either soft-tissue sarcomas or classic Ewing's sarcoma, but is defined as a distinct entity because of its immunohistological characteristics. The tumor expresses neuronal markers, but the pattern varies: chromogranin, neuron-specific enolase, synaptophysin, protein S-100 and others. MPNT can occur in the urogenital region. The differential diagnosis on clinical grounds must include Ewing's and soft tissue sarcomas, and also Wilms' tumor and its variants. MPNT are often wide spread in the urogenital region when first diagnosed. Response to radiotherapy and combination chemotherapy is limited. Radical surgery is not always possible. The prognosis therefore remains rather poor at this time. A selection of MPNT patients is presented to demonstrate the various problems associated with this diagnosis. MRI and CT of all patients showed large tumors with direct infiltration of the surrounding structures. MRI is the best imaging modality for diagnosis and therapy monitoring in these tumors, because of its high soft-tissue contrast.