Carcinoma in the defunctionalized urinary tract.

Carcinoma developing in the lower urinary tract diverted from the urinary stream, although uncommon, does occur and must be sought carefully in the presence of intractable pyocystis. Our experience with this condition is presented with emphasis on early diagnosis and treatment.

Comparison of microscopic and macroscopic repair in rabbit urethral fistulae.

Two fistulae were created in each of 26 adult male New Zealand rabbits. In six, no closure was carried out. In 20 rabbits subsequent closure was carried out using, alternately, a macroscopic and microscopic technique.

Vasovasostomy--is the microscope necessary?

Many techniques for vasovasostomy have been described, with each author suggesting his technique as the most effective procedure. Theoretical considerations such as leakage of sperm, obstruction, and narrowing of anastomosis suggest that a stentless technique with exact approximation of mucosal edges results in improved success rates. Careful macroscopic surgery with loupes, fine suture material, and experience on the part of the surgeon will give good results and pregnancy rates of 50 per cent.

Pathogenesis of urinary infection in patients with acute spinal cord injury on intermittent catheterization.

In a small pilot study urinary tract infection in patients with acute spinal injury was preceded by the establishment of Enterobacteriaceae on the introitus, glans and urethra. Those patients who retain the normal flora do not become infected. The first infection most commonly is by Escherichia coli with universal antibiotic sensitivities.

Guided percutaneous fine-needle aspiration biopsy of the liver.

Forty patients with suspected malignant disease of the liver underwent percutaneous fine-needle aspiration biopsy with radioisotope scintigraphic and fluoroscopic guidance. The needle was aimed at focal defects identified on the liver scan and several passes were made. When the scan was diffusely abnormal, the liver was widely sampled with multiple passes.

Pitfalls to avoid: psoas hypertrophy mimicking retroperitoneal fibrosis.

Mild obstructive uropathy and medial deviation of the ureters were observed in an athletic young black male, raising the possibility of retroperitoneal fibrosis. These findings were shown by computed tomography and ultrasonography to be due to psoas muscle hypertrophy.

Urinary tract infections due to Staphylococcus saprophyticus biotype 3.

Staphylococcus saprophyticus biotype 3 (Micrococcus subgroup 3 or M3) has usually been shown to be the second commonset cause of urinary tract infections in European women who are not in hospital. It generally causes pyuria and symptoms as severe as those caused by Escherichia coli. Unlike S.

Computed tomography in congenital anomalies of the aortic arch and great vessels.

Computed tomography can help in the evaluation of congenitally anomalous aortic arches and subclavian arteries. The authors discuss the role of computed tomography in the evaluation of such anomalies in seven patients.

The role of microsurgery in male infertility.

Microsurgery has become an important tool in the management of the infertile male. Although macrosurgical techniques are still required for preservation and protection of cryptorchid testes, microscopic techniques are also useful in the preservation of testicular tissue. We now use the microscope in all vasovasostomy and vasoepididyostomy procedures, but its final role in the treatment of male infertility has yet to be determined.

Radiation therapy for seminoma of the testis: results in British Columbia.

Between 1942 and 1978 radiation therapy was given to 362 patients with seminoma of the testis, 40 (11%) of whom had a history of maldescent of either testis. The disease was classified retrospectively according to the extent of the primary tumor, the involvement of the regional lymph nodes and the presence of distant metastases (the TNM system), and the results of treatment were analysed according to the classifications. Among the 275 patients referred for treatment at least 5 years before this analysis the 5-year survival rates were 87% overall, 96% for those with a T1 or T2 (relatively localized) tumour but no evidence of nodal involvement or distant metastases and 62% for the 24 with palpable or distant metastases at the time of clinical presentation.

Cecocystoplasty in the surgical management of the small contracted bladder.

Preliminary results have been reviewed for 17 patients with a small contracted bladder from chronic inflammatory disease who underwent cecocystoplasties. Except for 1 patient who was lost to followup results were considered excellent in 11, good in 2 and a failure in 3. The amount of diseased bladder resected and the configuration of the cecal segment used did not seem to bear any relationship to the surgical outcome.

Surgical management of Peyronie's disease.

Various forms of treatment have been advocated for Peyronie's disease but none has been entirely satisfactory. Recent reports in the literature indicate that surgical management consisting of excision and dermal grafting may not be the perfect cure suggested in the original report of Devine and Horton. The authors therefore review their experience in the use of the Devine-Horton technique emphasizing factors thought to be important for success.

The role of computed tomography in assessment of tumoral pathology of the adrenal glands.

The findings at computed tomography (CT) of the adrenal glands in 58 patients are presented. Most patients (50) were referred for suspected adrenal dysfunction. In three, adrenal masses were suspected from other radiological studies.

Vasovasostomy: a comparison of macroscopic and microscopic techniques at one institution.

During a 5-year period between 1973 and 1977, 87 patients underwent vasovasostomy to correct postvasectomy sterility. Sixty-one patients had single-layer macroscopic reanastomoses and 26 patients had two-layer microscopic reanastomoses. Patency rates of 90% and 96% and pregnancy rates of 46% and 54% for the macroscopic and microscopic techniques were achieved.

Primary malignant tumours associated with renal cell carcinoma.

Of 360 patients with primary renal cell carcinoma seen at the Vancouver General Hospital between 1957 and 1976, 33 had associated primary malignant lesions. A review of the 166 patients who had ablative surgery revealed that they were four times more likely to have a synchronous primary malignant tumour than the other patients. The incidence of asynchronous primary malignant tumours was not increased.

Surgical management of renal cell carcinoma at the Vancouver General Hospital: 20-year review.

Over a 20-year period 143 patients with renal cell carcinoma were treated surgically at the Vancouver General Hospital. The results of simple nephrectomy are compared to those of radical nephrectomy. The authors conclude that radical nephrectomy (including node dissection) is a useful staging procedure but provides little or no long-term therapeutic benefit over simple nephrectomy.

Idiopathic retroperitoneal fibrosis in children.

A case of idiopathic retroperitoneal fibrosis in an 11-year-old boy is presented. A review of 7 previous case reports revealed that there was no characteristic presentation in this disease process and that the diagnosis usually is suspected on an excretory urogram. The treatment is primarily surgical but corticosteroids may be helpful in selective cases.

Percutaneous fine-needle aspiration biopsy of the liver. Cytodiagnosis of hepatic cancer.

Percutaneous fine-needle aspiration biopsies of the liver were performed on 21 patients with a clinical suggestion of hepatic malignancy. Under the guidance of the liver scan, several aspirations at the suspect areas were made in each case, with an average of 3.4 punctures and 13.