Indications for and results of nephrectomy for metastatic renal cell carcinoma.

We find that, when metastases are present, a nephrectomy for renal cell carcinoma is not justified in the vast majority of cases. The only noncontroversial indication is for palliative nephrectomy which is performed to relieve intractable symptoms in the properly chosen patient. However, it is unusual to see a patient with tumor-related symptoms that cannot be conservatively managed.

Elevation of serum high density lipoprotein cholesterol by rowachol, a proprietary mixture of six pure monoterpenes.

Rowachol, a proprietary choleretic containing 6 pure monoterpenes markedly elevates serum HDL cholesterol (SHDL-C) concentrations in man. The concentration of SHDL-C showed a progressive increase in 16 patients treated with 6-9 capsules of Rowachol daily for periods of 2-28 weeks. There was no accompanying significant change in the concentrations of serum total cholesterol or triglyceride.

Pediatric pyleoplasty.

A series is reviewed of 153 pyeloplasties in 130 pediatric patients. Dismembering pyeloplasty was performed in most cases, usually with temporary nephrostomy drainage. A satisfactory anastomosis resulted in each case.

The lack of correlation between upper tract changes on excretory urography and significant vesicoureteral reflux.

In a retrospective review of all excretory urograms and voiding cystourethrograms performed in a 1-year period in 391 children evaluated with a history of urinary infection 56 (14 per cent) had vesicoureteral reflux as well as a normal excretory urogram. Of the 89 children in the study with vesicoureteral reflux 56 (63 per cent) had a normal excretory urogram. The grade of reflux was II or greater in 49 per cent of the cases, which also had a normal excretory urogram.

Spontaneous renal rupture in pregnancy.

A review of the literature reveals 9 cases of spontaneous renal rupture in pregnancy, to which we add another case. Most cases occurred in hydronephrotic kidneys. Four cases consisted of renal rupture without associated infection, or tumor, 3 were associated with abscesses, and 3 ruptured through renal hamartomas.

Whitaker test: differentiation of obstructive from nonobstructive uropathy.

The Whitaker test, a urodynamic study, combined with antegrade pyelography has been used recently to evaluate persistent upper urinary tract dilatation after operative correction of obstruction. This test will differentiate patients with residual or recurrent obstruction from those with dilatation secondary to permanent changes in the musculature. It is useful in evaluating patients with questionable ureteropelvic or ureterovesical junction obstruction, or primary defects in the ureteral musculature, such as prune-belly syndrome.

The prognostic value of cell surface antigens in low grade, non-invasive, transitional cell carcinoma of the bladder.

Tumors in 23 patients who presented with a low grade, non-invasive transitional cell carcinoma of the bladder were studied for blood group antigens A, B or O on the cell surface. Of 14 patients without cell surface antigens initially 13 suffered an invasive tumor subsequently and 1 had diffuse carcinoma in situ. Of 9 patients with cell surface antigens initially 8 did not have an invasive recurrence during a 5 or more-year followup and 1 did.

A hydroxamic acid from Aspergillus nidulans with antibiotic activity against Proteus species.

An iron-complexing antibiotic with a narrow spectrum of biological activity was produced by several strains of Aspergillus nidulans when grown in a low-iron, chemically defined medium. Its chemical and biological properties closely resembled those of desferritriacetylfusigen, a metabolite of several other Aspergilli and Penicillia.

Mass and number of fibres in the pathogenesis of asbestos-related lung disease in rats.

Five groups of rats were treated by inhalation for 12 months, with the U.I.C.

Radiographic findings in children surveyed for enuresis.

Over a one-year period 216 children had a radiographic survey of their urinary tracts performed for the evaluation of enuresis with many of these having a precedent history of urinary infection as well. Significant urinary tract abnormalities were found in 27 per cent of the children. Clinical correlation was obtained in 135 of these children with 19.

Beta-chain variants in Jamaican newborns.

In an electrophoretic study of 15,661 Jamaican cord bloods, 8 rare beta-chain variants were found in 18 subjects in addition to the common beta-chain variants, Hb S and Hb C. The heterozygote frequencies for Hb S and Hb C were 10.1% and 3.

Tapered ileum as ureter substitute in severe renal damage: antireflux technique for bladder implantation.

Three cases are reported in which ileum has been used to replace irreparably damaged ureters despite preexisting moderate to severe pyelocaliectasis. Two cases have had satisfactory results while one had increasing pyelocaliectasis and azotemia requiring subsequent cutaneous diversion. The rationale for using ileum to replace ureter is presented with a discussion of objectives to be achieved surgically to assure the success of the procedure.

A comparison of the morbidity associated with radical retropubic prostatectomy with and without pubectomy.

Radical retropubic prostatectomy with bilateral pelvic lymphadenectomy for prostatic carcinoma was done with pubectomy in 8 patients and without pubectomy in 8 other patients. A comparison of the postoperative courses reveals an excess morbidity in patients who had pubectomy, with severe protracted pelvic girdle pain in 75 per cent, lower extremity thrombophlebitis in 37 per cent (one of which resulted in a non-fatal pulmonary embolus) and varying degrees of urinary incontinence persisting for 6 months or more in 75 per cent. In contrast, in patients who did not have a pubectomy mild transient pelvic girdle pain was noted in only 25 per cent of the cases, late lower extremity thrombophlebitis in 12 per cent and no late urinary incontinence.

Ileal conduits in children at the Massachusetts General Hospital from 1955 to 1970.

The 45 ileal conduits performed on children at the Massachusetts General Hospital from 1955 to 1963 are reviewed and compared to the 45 ileal conduits performed from 1964 to 1970. Late complications involving the conduits occurred in 60 per cent of the early group and in 51 per cent of the late group. Of the renal units judged normal pyelographically preoperatively in the early group 77 per cent went on to at least some deterioration, while 62 per cent of the late group judged normal later deteriorated.