ChM (Poland)

This study was undertaken to determine the relative accuracy of computerised Doppler waveform analysis and colour coded duplex ultrasonography in the diagnosis of arteriogenic impotence. Twenty men with ostensibly normal penile haemodynamics were compared with 50 men whose impotence was considered due to compromised penile haemodynamics. In each patient the penile arterial inflow was assessed by both methods of investigation, which were performed at an interval of 2 weeks. The results demonstrated both techniques to be sensitive in detecting penile artery insufficiency but colour coded duplex ultrasonography was significantly more accurate.

The axillary arch is reported to occur in 7% of the population, but in our experience has only been observed in 0.25%. The anatomical features are described and its importance in axillary dissection is indicated. In addition, its relevance to the prevention of lymphoedema and to the construction of latissimus dorsi flaps is discussed. The axillary arch should be considered in the differential diagnosis of axillary swellings.

The red cell membrane stearic acid to oleic acid ratio was analysed in 34 men with histologically proven carcinoma of the prostate and distant metastases. This ratio was expressed as the saturation index (SI). A mean SI of 0.97 was found in control patients without evidence of any malignancy whereas all patients with advanced prostatic cancer showed a reduced stearic to oleic acid ratio (mean SI 0.466). Untreated patients had a significantly lower SI (mean 0.36) than those who had responded to hormonal therapy (mean 0.547; P less than 0.0001). A drop in SI correlated well with more advanced disease as judged by radiological findings and serum PSA. It is suggested that red cell membrane SI correlates well with radiological and biochemical markers of advanced prostatic carcinoma and may be used as a marker to assess progress and response to treatment.

Ketoconazole 400 mg 8-hourly was used as primary hormonal treatment in 12 patients with advanced prostatic carcinoma. Four patients were withdrawn because of side effects and 1 died. The 7 patients who tolerated the drug had a reduction in testosterone and adrenal androgens. Six patients were fully evaluable. There was one partial response with complete remission of symptoms. Two patients enjoyed a subjective response and 3 showed no response. Ketoconazole had an effective biochemical action but the side effects seen in this study severely limit its usefulness. Ketoconazole has now been withdrawn as a treatment for prostatic cancer. However, less toxic derivatives might prove a useful addition to the drugs available to treat this condition.

Between 1977 and 1984, 92 patients with clinical Stage II non-seminomatous germ-cell testicular tumours were treated by primary chemotherapy, with surgery reserved for the excision of persisting masses. Eighty patients (87%) are alive and disease-free: 96% for Stages IIA and IIB and 74% for Stage IIC. Of 43 Stage IIA, B and C patients treated with bleomycin, etoposide and cisplatin (BEP), 40 (93%) are disease-free. For the whole group there was a significant difference between the outcome of treatment in patients with retroperitoneal masses greater than 8 cm in transverse diameter compared with those in whom masses were less than 8 cm, the disease-free rates being 54 and 97% respectively. Primary histology did not influence the outcome of treatment. However, whereas 51% of patients with teratocarcinoma had masses resected after chemotherapy, only 26% of embryonal carcinoma patients came to surgery. The results obtained in this series are as good as those obtained when lymph node dissection is employed as the initial form of treatment. The avoidance of surgery with preservation of ejaculatory function in 78% of Stage IIA and IIB patients argues in favour, of an initially non-surgical approach to management.

Historically, the separation of bilirubin (bil) into conjugated & unconjugated fractions provided an important tool for the diagnosis of jaundice. Progress in HPLC has furnher allowed the identification of 4 species of bilirubin: unconjugated (α) monoconjugated (β), diconjugated (γ) bil, & lately, a bil specie (δ) that is tightly bound to albumin. Unlike in the adult, there is little information on the significance of these 4 species of bilirubin in jaundiced infants. This study addresses this problem & opens new avenues for the future study of janudice in infants. METHODS: 24 infants were prospectively studied with jaundice due to: physiologic (13) hemolytic (3) prematurity (2), biliary atresia (2), cholangitis (1), CMV (1), hepatitis (1), unknown (1). Serial total (TB) and direct (DB) bilirubin were analyzed by Jendrassik-Grof (diazo) method. Bilirubin species (expressed as %TB) were detected by reverse phase HPLC. RESULTS: (1) infants with physiologic/hemolytic jaundice showed >90% as α bil. Direct bilirubin, if elevated, was either β or γ, whereas δ was consistently low (<5%). (2) infants with direct hyperbilirubinemia (DB>1.0 mgs%) showed β > γ by ratio of 3:1. In general, DB was underestimated by 30-50% by diazo tests compared to HPLC. (3) δ bil was seen in most infants with elevated DB and constituted from 8-73% (mean=22%) of TB: it was detected as early as at birth in a patient with hepatitis/atresia; it persists for a long period and its % increases with the duration of jaundice, inversely proportional to declining TB. CONCLUSION: The study of jaundiced infants, particularly those with high direct bil requires further demonstration of the different bilirubin species, not only because direct bilirubin is grossly underestimated by diazo tests, but that the bilirubin species may provide information that can lead to a better understanding and study of the disease.

Summary— A significant improvement in the incidence of urinary tract infection following transurethral resection of prostate was obtained during the first 4 years of a new urology department. These results, aided by wound infection rates derived from the Hospital Infection Surveillance programme, suggest the desirability of urology departments being separate, specialised units and point to the usefulness of an Infection Control Team.

Thomas shunts have been utilized 24 times in 20 patients to provide secondary vascular access in an often poor-risk group of patients, including children. Twenty of the shunts were on the iliac vessels. Five shunts are in current use, the longest having been in situ for 83 months. Another 13 shunts provided access until renal transplantation or death of the patient. Six shunts developed deep infection which usually extended to the Dacron-arterial anastomosis; the management of these infected iliac shunts was difficult and hazardous. No definite advantage for the iliac placement of shunts has been established, and its use at this site cannot be recommended. Although the Thomas shunt can provide good long-term access, our experience suggests that its use should be limited to that of a "shunt of last resort".