A prospective evaluation of the management of acute pyelonephritis in adults referred to urologists.

In order to assess whether it is appropriate and clinically efficient to admit adults with 'clinically diagnosed' acute pyelonephritis (APN) under urologists, as is current practice in many NHS hospitals, a prospective study was undertaken over nine months in an NHS teaching hospital. Thirty-nine patients with clinical APN were admitted to the urology unit; all were pyrexial and 30 (77%) had typical features of rigor, flank pain and irritative lower urinary tract symptoms. Twenty-one (54%) had positive urine cultures, 31 (79%) had parenteral antibiotics, while another three (7%) had oral agents initially.

Endo-urological techniques in the management of stent complications in the renal transplant patient.

Complications following renal allograft transplantation have been well documented and, despite improvements in technique, continue to cause significant morbidity and mortality. The placement of indwelling ureteric stents is becoming more common both during primary neo-ureterocystostomy and in the management of subsequent ureteric complications. We present two cases of stent encrustation and urolithiasis treated by a combined percutaneous and flexible ureterorenoscopic approach.

Reversible hypertension in a young female: ureteric obstruction due to endometriosis.

We present the case of a young female who, upon investigation for hypertension, was found to have a ureteric stricture secondary to endometriosis. After excision of the stricture and an end-to-end ureteric anastomosis the patient's blood pressure returned to normal. This case highlights the need to investigate fully hypertension in young people and to consider the possibility of endometriosis in any female who presents with obstructive uropathy.

Empowering a tea-plantation community to improve its micronutrient health.

This project was designed to convince and empower management and plantation workers to improve their own nutritional health status and productivity. Plantations are generally bypassed by the government's primary health-care system. A nine-month intervention with iron (60 mg of elemental iron) and vitamin A supplementation and iodized salt was performed on the Balanoor Plantations in India.

Transurethral prostatic resection or laser therapy for men with acute urinary retention: the ClasP randomized trial.

Purpose: Transurethral resection of the prostate is the standard operation for acute urinary retention, although laser prostatectomy is reportedly effective and safe. The ClasP (conservative management, laser, transurethral resection of the prostate) study compared transurethral prostatic resection and noncontact neodymium (Nd):YAG visual laser assisted prostatectomy for treatment of acute urinary retention.

Materials And Methods: This study was a multicenter randomized controlled trial, analyses were by intention to treat and followup was at 7.

Burkitt's lymphoma of stomach: A case report and review of literature.

Primary gastrointestinal non-Hodgkin's lymphoma is a distinct clinicopathological entity. This is the commonest site of all extranodal lymphomas. Non-endemic Burkitt's lymphoma (high-grade, small non-cleaved lymphocytic type) is rare in non-HIV adult population.

Undifferentiated leukemia following treatment of gastric cancer with 5 fluorouracil, doxorubicin, mitomycin C chemotherapy.

Secondary leukemias are an increasingly well recognized complication of cancer chemotherapy. We report on the development of undifferentiated leukemia in a forty one year lady, eighteen months after treatment of gastric cancer with 5-fluorouracil (5 FU), doxorubicin and mitomycin C. She developed progressive weakness and pancytopenia over a period of few months.

Bilateral superselective arterial microcoil embolisation in delayed post-traumatic high flow priapism.

High flow arteriogenic priapism is uncommon and usually occurs after trauma to the genitoperineal area. The onset of prolonged erection can be delayed and is often relatively pain free. Arteriography in this case illustrated the causative bilateral arteriocavernosal fistulae and pseudoaneurysms.

Granular acute lymphoblastic leukemia with hypereosinophilic syndrome.

A four-year-old boy presented with marked peripheral blood eosinophilia (absolute eosinophil count of 54 x 10(9)/1), features of hypereosinophilic syndrome, and acute lymphoblastic leukemia (ALL-L2), the latter characterized by the presence of granular blasts. Blasts were negative for myeloperoxidase, non-specific esterase, acid phosphatase, periodic-acid Schiff stain, and toluidine blue. They exhibited an early pre-B immunophenotype (TdT, CD19, CD10, CD20 and CD22 positive) and stained negative for T (CD7, CD2, CD5 and CD3) and myeloid markers (MPO, CD33 and CD13).

A randomized trial comparing transurethral resection of the prostate, laser therapy and conservative treatment of men with symptoms associated with benign prostatic enlargement: The CLasP study.

Purpose: We evaluated the effectiveness of a new technology (noncontact laser therapy) versus that of standard surgery (transurethral prostatic resection) and conservative management for lower urinary tract symptoms associated with benign prostatic enlargement.

Materials And Methods: Men with uncomplicated lower urinary tract symptoms, that is no acute or chronic urinary retention, were randomized to receive laser therapy with a noncontact, side firing neodymium:YAG probe, standard transurethral prostatic resection or conservative management, including monitoring without active intervention, in a large multicenter pragmatic randomized controlled trial called the CLasP study. Primary outcomes were International Prostate Symptom Score (I-PSS), maximum urinary flow rate, a composite measure of success based on I-PSS and maximum urinary flow rate categories, I-PSS quality of life score and post-void residual urine volume.

A prospective randomized trial comparing transurethral resection of the prostate and laser therapy in men with chronic urinary retention: The CLasP study.

Purpose: We assessed the effectiveness of laser therapy versus transurethral prostatic resection in men with symptomatic chronic urinary retention secondary to benign prostatic enlargement.

Materials And Methods: This trial was multicenter, pragmatic and randomized. Analysis was done by intent to treat.

Tuberculosis: a rare cause of splenic abscess.

Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.

Extramedullary myeloid cell tumour: presentation as anterior chest wall mass during AML relapse.

Acute myeloid leukaemia is an uncommon but an important cause of soft tissue swellings. Such extrameningeal, extramedullary leukaemic infiltrates are called extramedullary myeloid cell tumours. Despite their large size they may respond well to chemotherapy and local radiotherapy, as is demonstrated in this case.

Extramedullary myeloid cell tumor of the urinary bladder in a patient with myelodysplastic syndrome.

We report a case of extramedullary myeloid cell tumor of the urinary bladder in an elderly male with a three year history of myelodysplastic syndrome (refractory anemia with excess blasts), noninvasive papillary transitional cell carcinoma of the urinary bladder, and in situ transitional cell carcinoma of the left ureter. Light microscopy demonstrated a poorly differentiated neoplasm composed of medium to large cells with eosinophilic cytoplasm. The tumor cells showed immunohistochemical expression of myeloperoxidase, lysozyme, CD15, CD68 and CD43.

Internal iliac artery embolisation for intractable bladder haemorrhage in the peri-operative phase.

Intractable haemorrhage from the bladder wall during transurethral resection of bladder tumour is uncommon but potentially catastrophic. Internal iliac artery embolisation is a minimally invasive technique, which is now widely practised to stop bleeding from branches of these arteries is situations including pelvic malignancy, obstetric and gynaecological emergencies and trauma. We report its successful use peri-operatively, in an unfit, elderly patient with uncontrolled bleeding.

Fine needle aspiration of extramedullary myeloid cell tumor in myelodysplastic syndrome. A report of three cases.

Background: Soft tissue tumors are rare in myelodysplastic syndrome (MDS), and the role of fine needle aspiration (FNA) cytology in their diagnosis has not been explored.

Cases: Two patients with refractory anemia with excess blasts in transformation (RAEB-t) developed soft tissue swellings during the course of the illness. In a third patient, soft tissue swelling was a presenting feature.

Suprapubic catheterization: a suitable procedure for clinical nurse specialists in selected patients.

Objective: To assess the feasibility and advantages of urology clinical nurse specialists (NSs) extending their professional role to include inserting initial suprapubic catheters in selected patients in the hospital and community setting.

Patients And Methods: A urology NS, who is also the district continence adviser, was formally taught by a consultant urologist how to insert suprapubic catheters using the 'Add-a-Cath' introducer technique (Femcare, UK). Once deemed competent, the NS was indemnified by the Trust to carry out the procedure in carefully selected patients using a safe and unequivocal protocol.

Ocular extramedullary myeloid cell tumour in children: an Indian study.

Thirty-two children with extramedullary myeloid cell tumour (EMT) who constituted 41 per cent of children with acute myeloid leukaemia (AML) were studied to ascertain their laboratory characteristics and potential problems in diagnosis. The diagnosis, established by peripheral blood smear and/or bone marrow examination, was AML (n = 29) and refractory anaemia with excess blasts in transformation (RAEB-t; n = 3). The six referred patients in whom the diagnosis had been missed, and two cases wrongly reported as histiocytosis on aspiration cytology, were those in whom a peripheral blood smear had not been examined.