Vena cava tumor thrombus from renal cell carcinoma arising from adrenal vein.

Renal cell carcinoma is a highly vascular tumor with the propensity to propagate along venous channels. Vena cava tumor thrombi are reported to occur in approximately 4-10 per cent of cases and requires modification of the standard radical nephrectomy. We report the first 3 cases of vena caval tumor thrombus emanating not from the renal vein, but from the adrenal vein.

Radical retropubic prostatectomy.

We herein present a modification of the Campbell technique for radical retropubic prostatectomy used in 75 consecutive patients undergoing surgical extirpation of the malignant gland. This technique provides for predictable and careful anatomic removal of the prostate. The postoperative complications have been minimal and urinary incontinence has been negligible.

Neurogenic pulmonary edema associated with autonomic dysreflexia.

Neurogenic pulmonary edema is associated with a variety of central nervous system injuries and results from a massive centrally mediated sympathetic discharge. Another syndrome characterized by sympathetic overactivity is autonomic dysreflexia, which occurs in patients with spinal cord injury above T4 to T6. We describe a patient with a cervical spinal cord injury who had intense, prolonged autonomic dysreflexia following external sphincterotomy, which culminated in pulmonary edema.

Urinary lactic dehydrogenase and serum C-reactive protein as means of localizing the site of urinary tract infection in patients with ileal conduits.

Many patients with ileal conduit urinary diversion have infected urine but far fewer have clinical pyelonephritis. A noninvasive diagnostic test to distinguish renal bacteriuria from conduit colonization in these patients would seem desirable. Urine total lactic dehydrogenase and lactic dehydrogenase isoenzymes, and serum C-reactive protein have been useful to distinguish pyelonephritis from cystitis in patients with intact urinary tracts.

Antibody-coated bacteria in urine of patients with ileal conduit urinary diversion.

The antibody-coated bacteria (ACB) test is a helpful adjunct for differentiating pyelonephritis from cystitis in the intact urinary tract, particularly in female patients. This test was used in patients with ileal conduits and infected urine in an attempt to determine whether bacilluria was of renal or conduit origin. Every patient with infected conduit urine had a positive ACB test even though no patient had clinical stigmas of acute pyelonephritis.