Emphysematous pyelonephritis and renal amoebiasis in a patient with diabetes mellitus

Emphysematous pyelonephritis is an uncommon and life-threatening infection of the kidney that is characterized by gas formation within or around the kidney and is associated with diabetes mellitus and urinary tract infection. Amoebiasis is a protozoal infection caused by Entamoeba histolytica. In its invasive forms, the disease is characterized by visceral abscess formations. We present a case of concomitant emphysematous pyelonephritis and renal amoebiasis in a 42-year-old female with uncontrolled diabetes mellitus. The patient did not respond well to initial supportive treatment and antibiotherapy. Therefore, nephrectomy was performed. She did extremely well after the operation and was discharged with antidiabetics and antibiotics.     

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

Spontaneous expulsion of a bullet via the urethra

The rare clinical occurrence of the spontaneous passage of bullet which was not found during an operation after a gunshot wound to the bladder in a 28-year-old man is described.     

Correlates of Dysmenorrhea

A study was conducted to explore the relationship of demographic variables, gynecologic history variables, and menstrual attitudes to three measures of dysmenorrhea derived from the Menstrual Distress Questionnaire. One hundred ninety-three women, 18 to 35 years old, from five neighborhoods in a large, metropolitan city comprised the sample population. The strongest correlates found were attitudes toward menstruation, though associations between dysmenorrhea and items reflecting traditional/feminist dimensions were absent. Further precision in defining dysmenorrhea and a comprehensive, health-oriented approach to dealing with menstrual distress is indicated. Recommendations about the nurse's role in counseling dysmenorrheic women and promoting more positive menstrual attitudes are discussed.     

The effect of abdominal surgery on the serum concentration of the tumour-associated antigen CA 125

Summary. The CA 125 assay is used to monitor the course of disease in women with adenocarcinoma of the genital tract. We measured serum CA 125 levels longitudinally in three different groups of patients who had normal scrum CA 125 levels (16 U/ml) before extensive intraperitoneal abdominal surgery (group 1, second-look laparotomy in 28 women with ovarian cancer; group 2, radical hysterectomy in 42 patients with cervical cancer; group 3,13 men and one woman who had aortic surgery for atherosclerotic occlusive disease or aneurysm formation). Following surgery, rising serum CA 125 levels were observed in 69 out of the 84 patients (82%), irrespective of the primary diagnosis, type of operation or sex. The highest levels were found during the second week after the operation (range 3–336 U/ml) and decreased gradually thereafter, to become normal at 8 weeks after surgery. It was concluded that abdominal surgery interferes with the specificity of CA 125 as a tumour marker during the early postoperative period.     

Intratesticular varicocele: Report of two cases

Intratesticular varicocele is a rare entity and describes dilated intratesticular veins radiating from the mediastinum testis into the testicular parenchyma. Scrotal ultrasonography of two patients who presented to our urology clinic due to left scrotal pain revealed multiple tubular structures in the testes with diameters of more than 2 mm. Duplex spectral analysis showed a reversed flow response to Valsalva's maneuver. Apropos of two cases, intratesticular varicocele is reviewed.     

Adenosquamous carcinoma of the prostate

Adenosquamous carcinoma of the prostate is an unusual histological variant of prostate cancer. The histogenesis of this tumor remains uncertain. The stimulus for the development of the squamous metaplastic cells had been thought to be related to hormone and/or radiation therapy. This report presents a case of adenosquamous carcinoma of the prostate with abscence of previous hormone or radiation therapy. The case showed negative prostate-specific antigen and high molecular weight cytokeratin staining of the adenocarcinoma component, and negative prostate-specific antigen and positive high molecular weight cytokeratin staining of the squamous cell carcinoma component. The adenocarcinoma component stained intraluminally with periodic acid schiff. The staining features and the distinct localizations of the components with intermingling, but no transition, are against the collision-type tumor theory and support the theory that the adenocarcinoma and squamous components arise de novo from pluripotent stem cells. The patient had a rapid downhill clinical course and died 3 weeks after the diagnosis was made.     

Evidence for differential human slow-wave activity regulation across the brain

The regulation of the timing of sleep is thought to be linked to the temporal dynamics of slow‐wave activity [SWA, electroencephalogram (EEG) spectral power in the ～0.75–4.5 Hz range] in the cortical non‐rapid eye movement (NREM) sleep EEG. In the two‐process model of sleep regulation, SWA was used as a direct indication of sleep debt, or Process S. Originally, estimation of the latter was performed in a gross way, by measuring average SWA across NREM–REM sleep cycles, fitting an exponential curve to the values thus obtained and estimating its time constant. In later studies, SWA was assumed to be proportional to the instantaneous decay rate of Process S, rather than taken as a direct reflection of S. Following up on this, we extended the existing model of SWA dynamics in which the effects of intrusions of REM sleep and wakefulness were incorporated. For each subject, a ‘gain constant’ can be estimated that quantifies the efficiency of SWA in dissipating S. As the course of SWA is variable across cortical locations, local differences are likely to exist in the rate of discharge of S, eventually leading to different levels of S in different cortical regions. In this study, we estimate the extent of local differences of SWA regulation on the basis of the extended model of SWA dynamics, for 26 locations on the scalp. We observed higher efficiency of SWA in dissipation of S in frontal EEG derivations, suggesting that SWA regulation has a clear local aspect. This result further suggests that the process involved in (local) SWA regulation cannot be identical to the Process S involved (with Process C) in effectual determination of sleep timing – a single behaviour that cannot vary between locations on the scalp. We therefore propose to distinguish these two representations and characterize the former, purely SWA‐related, as ‘Process Z’, which then is different for different locations on the scalp. To demonstrate those differences, we compare the gain constants derived for the medial EEG derivations (Fz, Cz, Pz, Oz) with each other and with the decay rate derived from SWA values per NREM–REM sleep cycle.     

Study on the histamine-like activity of guanfacine

The effects of guanfacine have been studied on guinea-pig isolated atria and diethylstilboestrol-treated rat isolated uterus to determine whether it possesses histamine-like activity. Guanfacine produced a concentration-dependent negative chronotropic effect which was not modified by ranitidine (0.1 microM). In rat isolated uterus contracted by KCl, clonidine (5-5000 microM) produced concentration-dependent relaxation which was blocked by ranitidine (0.1 microM), but guanfacine only produced relaxation at high concentrations (100-1000 microM), and this was not affected by ranitidine (0.1 microM). It is concluded that guanfacine, unlike clonidine, does not produce effects due to activation of H2-receptors in either guinea-pig atria or rat uterus.