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Thrombosis in a renal artery occurred in a 60-year-old woman after regional hypothermia of the kidney for which balloon occlusion of the artery had been used. Perfusion of the kidney was re-established by aspiration and flushing of the thrombus; this was confirmed angiographically and anatomically. Renal function did not recover, however, since removal of the thrombus by means of an angiographic catheter was carried out too late. We regard early aspiration of emboli from major abdominal vessels as a further application of arterial catheterisation by the Seldinger technique.

The prognosis of renal cell carcinoma correlates with the aggressiveness of surgery, especially in patients with involvement of the vena cava. Without significant bleeding the operative management and the successful removal of a free floating tumor thrombus from the vena cava has been described. In a 69-years old female patient the vascular surgery consists of cross clamping of the vena cava with free back-flow of the contralateral renal vein, cavotomy, insertion of a Fogarty catheter for occlusion of the suprarenal vena cava without blocking the liver veins, and extraction of the thrombus.

In a study with 30 randomized patients the pharmacokinetics, efficacy and side effects of Sisomicin were determined. Half of the patients received one single intramuscular injection of 75 or 100mg (1.4 mg/kg) Sisomicin/day. The other cases were injected 50 or 75mg (1.9 or 2.1 mg/kg) b.i.d. The serum concentrations determined on the first and last days of treatment 1 hour after the application ranged between 4 and 5.3 mug/ml. After 6 hours the values decreased to 0.7-0.8 mug/ml. The elimination rate within 24 h amounted to 63-77%. Depending on the dosage group, the mean urinary concentrations/24 h amounted to 46-51 mug/ml or 63 to 92 mug/ml, respectively. The highest concentration measured during the first 8 hours amounted to 129 mug/ml after an administration of 1.4 mg/kg. In 18 of 29 cases a "cure" of urologic infections, most of which had been treated previously without success, could be achieved. Furthermore we observed 5 relapses, 3 failures and 3 reinfections, but no superinfection. The local and general tolerance of Sisomicin was good. 5 patients showed toxic reactions of the vestibular organ in the form of dizziness. In 1 case there was an excretion of granulated casts.

On the background of the advantageous prognosis of patients with testicular tumors we define subgroups in which therapy can be reduced. Basing on the distribution of metastases, especially the localisation of solitary nodes, staging LA may be limited to certain regions in patients with non-seminomas. The modification of irradiation fields for seminomas is difficult as the predictive value of negative diagnoses (CT, sonography, lymphography) is only 77%. As the topography of metastases does not differ within the various T-categories, the necessary extent of irradiation cannot be related upon them. In clinical stage I contralateral iliacal fields have not to be included. In left-sided tumors no positive solitary nodes were found in the ipsilateral iliac region, subsequently we suppose that this area might be preserved. In right-sided tumors occasional solitary nodes in the ipsilateral field are not necessarily due to an infiltration of the epididymis; therefore we recommend in general a prophylactic irradiation of the ipsilateral iliac region. An inguinal irradiation should be reserved only for pre-operated patients and an involvement of the scrotal wall.

For quantitative, histologic assessment of the testis tubuli there are four suitable parameters: diameter of tubulus, area of tubulus, number of cell nuclei per tubulus, and area of nuclei of the various cells participating in spermatogenesis. For estimating areas, the integrative method of measurement, either with a grid or with the aid of the manual optical picture-analysis system, is proposed. The tubulus diameter can be determined rapidly and easily, although the tubulus size can be assessed more accurately by area estimation. An assessment of reproductive capacity in detail is possible by means of rather time-consuming determination of cell nucleus number and nuclear area, whereby the stages of the cycle of the seminiferous epithelium must be considered.

The functional condition of seminal vesicles can be judged on the basis of spermatic fructose. In dealing with the causes of fructose deficiency, one must distinguish between androgen-dependent and androgen-refractory deficiencies. The main causes of androgenic-refractory fructose deficiency are specific and unspecific inflammations of the masculine adnexa. The example of spermatocystic tuberculosis demonstrates the importance which must be given to specific inflammation of the masculine adnexa, during fertility-consultation hours.

Percutaneous needle puncture of space-occupying lesions is an innocuous procedure in the differential diagnosis of renal masses. In conjunction with intravenous urography, ultrasonography and CT-scan it is a method of considerable diagnostic value, which will lead to a nearly complete accurate diagnosis. In this study we will report our experiences with diagnostic and therapeutic puncture of renal cysts. The instillation of Lipiodol has been given up, since a follow-up study became impossible due to radiological problems. The diagnostic procedure to differentiate expanding lesions of the kidney and the technique of percutaneous needle puncture are described as well as indications for surgical exploration.

Register and Multicenter Study for Testicular Tumours Bonn was founded in September 1976. Until August 1981, from 46 institutions participating in Austria and the Federal Republic of Germany the data from a total of 1508 patients with testicular tumours have been collected and evaluated. This paper gives an overview on the data available at the moment, and especially informations on the age distribution (children 3.6%, men over 50 years 6.3%), predisposing factors (maldescensus testis 8%, atrophy 6%), masking factors (hydrocele 7%, trauma 7%) and duration of anamnesis (average 136 days).

In 31 patients with unilateral idiopathic varicocele it was sought to correlate spermiogram and morphology of testis, particularly germinative epithelium, interstitial connective tissue and blood vessels. In both testes of all of 12 patients with pathological sperm striking morphological changes were found, from depletion of germinative cells to Sertoli-cell-only syndrome and including fibrosis of the interstitial tissue, reduction and occasionally diffuse or nodular hyperplasia of the Leydig cells as well as typical vascular changes. Due to alterations to the vascular walls the germinative epithelium had degenerated, this accounting for sub- and infertility, In the prophylaxis of fertility disturbances, the findings indicate that the same aspects apply to both varicocele and undecended testis.

Reviewing the literature, it can be conducted that malignant testicular tumors are rare in childhood and can be cured in 80% of cases by orchiectomy alone. Disseminated testicular tumors in children were treated by different combinations of cancer chemotherapy, and in 10 of 24 cases remissions were achieved. Therapeutic recommendations do not exist for childhood. In adults longterm remissions can be attained in the majority of patients with disseminated testicular teratomas by vinblastine and bleomycin alone respectively with additional cisplatinum. Further drugs did not augment the rate of complete or long-term remissions. Combination of vinblastine and bleomycin requires high dosage and a 5 day course of bleomycin. By adding cisplatinum, vinblastine in high dosage (over 0.4 mg/kg) and bleomycin as continuous infusion are no longer necessary. Remission maintenance therapy does not prevent relapses. In patients with relapse ifosfamide and etoposide in combination with cisplatinum frequently are still effective.

Varicoceles were encountered in 21.9% of 2752 men at draft and in 16% of 818 sanatorium patients. There was no decreasing incidence in the latter with increasing age. Fathers were encountered almost equally frequently among men with varicoceles as in men without varicoceles. Varicocelectomy seems to be indicated only when further children are wanted, when abnormalities of the spermiogram are present or testicular abnormalities can be detected on palpation. The validity of preventive removal of varicoceles in adults needs to be ascertained in a randomised and prospective study with concomitant registration of pregnancy rate and spermiograms.

The behavior of various enzymes in the orthotopic and dystopic dog testis was examined under the conditions of experimental unilateral cryptorchism after HCG-treatment over a period of 3 months. The following findings could be obtained: 1. Under the HCG-application the orthotopic impuberal testis there was a change of behavior of the enzyme in the tubuli and Leydig-cells in comparison with test animals. A loss of LDH of the epithelium of the tubuli can be avoided through HCG-treatment. 2. In the dystopic testis of the impuberal animal, HCG cannot avoid this loss of LDH in the epithelium of the tubuli. In the Leydig cell complexes the Glucose-6-Phosphate-Dehydrogenase shows an increase of activity. 3. In the Leydig cell complexes of the impuberal testis an apparent loss of LDH is noticeable in the epithelium of the tubuli, while the non-specific esterase, SDH and the Glucose-6-Phosphate Dehydrogenase increases in activity. The activity of the Leydig cell complexes shows the expected stimulation. The present results prove that under a large dose of HCG-treatment can lead to different changes in the enzymes of the orthotopic testis of dogs.

This report concerns 18 patients with germinal testicular tumors in whom the resection of pulmonary metastases was indicated following resection of the primary tumor and combined cytostatic therapy. Nine patients underwent a retroperitoneal lymphadenectomy immediately after semi-castration. Upon follow-up examination, circular pulmonary foci were visualized by conventional films or computerized tomography. These patients developed pulmonary metastases on the average 8 months after the first operation (semi-castration and lymphadenectomy). Since 1978, a combined cytostatic treatment has preceded the lymphadenectomy and resection of parenchymal metastases. No evidence of disease (NED) could be achieved in 9 patients by resection of pulmonary metastases, with an average follow-up period of 30 months. The results in surgery of metastases are judged as the more advantageous, the longer the free interval is between initial disease onset and the occurrence of metastases.

The androgen receptor in fibroblasts cultured from a biopsy of scrotal skin from 1 subject with Reifenstein syndrome has been found to be normal in amount and to bind dihydrotestosterone with normal affinity but to be qualitatively abnormal as evident by thermolability and instability upon ultracentrifugation. The family study of this subject and endocrine studies document androgen resistance in the index patient and his affected uncle. These findings provide evidence for X-linkage of this disorder, and suggest that the mutations that give rise to this phenotype are probably allelic to the mutations of the androgen receptor that cause testicular feminization.

In the literature 59 cases of multicystic dysplasia of the kidney in adults have been reported. Many authors use different descriptions to characterize the same aspect of identical disease causing a confusing nomenclature. The disease is caused by a malformation in development. On the basis of three clinical case reports diagnosis, differential diagnosis and prognosis is discussed. One patient had an additional malformation (M. Klippel-Feil).

Lymphography and computer tomography was performed on 64 patients with malignant testicular tumours in order to demonstrate lymph node metastases. In 60 patients it was possible to confirm the findings by surgery. In 43 patients there was agreement between the findings of the computer tomogram and the lymphogram. In 39 of these patients lymph node metastases had been demonstrated, in three there was a false negative and in one a false positive. Amongst the patients in whom there was a descrepancy between the two types of examination, the CT findings were confirmed histologically in twelve, and the lymphographic findings in nine. In 12.5% CT added significant additional information. Accuracy of lymphography was 73% and of computer tomography 80%. Specificity for each examination was 79%.

Of 250 testicular tumors treated up to May 1975 233 (93.2%) were germ cell and 17 (6.8%) non-germ cell tumors. Reexamining the histology of the last 123 patients only 29.3% had pure seminomas and 70.7% had non-seminomatous tumors. The results of regimens of combined surgical (extended semicastration and lymphadenectomy) and chemotherapeutic (triple-drug as well as Ifosfamid in combinations with low-dose radiafor stage II (37.5%) and stage II (16.7%). There were good results after 96 transperitoneal bilateral lymphadenectomies. But even in stages II and III results were achieved which would not have been possible without lymphadenectomy. It is pointed out that in the future, with improvements in cytostatic therapy, even better results including treatment of stage IV tumors can be expected.

Malignant testicular tumors mainly occur in early adult life. 14 (7.8%) of our 180 patients with testicular tumors, treated from 1966 to 1976, were between 50 to 68 years of age. The pathological anatomical classification showed 9 germinal and 5 non-germinal tumors. To find out which tumor classification is the best for prognostic information and assessment of therapeutic consequences, we recommend setting up a central testicular tumor panel and register and refer to the multilateral study already initiated.

In a multicenter randomised clinical comparative study 96 urological patients with established urinary tract infection were treated in 50% with 2 g mezlocillin three times and in 50% with 1.5 g cefuroxime three times. Both antibiotics were shown to be antibacterially active substances with a high bacterial elimination rate. Three days after cessation of treatment the urine was sterile in 79 cases. Follow-up investigations 1-2 weeks later showed that the number of recurrences and reinfections was higher in the cefuroxime group than in the mezlocillin group. This difference is statistically significant so that mezlocillin can be considered the more effective antibiotic. Clinical and urine cytological results correlated with bacteriological results. Side effects were observed rarely, and toxic effects not at all.

The German society of Pediatric Oncology (GPO) designed in 1982 a cooperative study to improve the outlook of patients with malignant testicular germ cell tumors (MAHO 82). So far the combined modality therapy was effective to increase the relapse free survival (Haas et al. 1988). From the data the MAHO 88 protocoll was outlined as follows: Yolk sac tumor: Unilateral orchiectomy; Stage I A - wait and see. Stage I B/C-IV 4 courses standard chemotherapy. If alpha-feto-protein after 2 courses is still positive explorative laparatomy has to be performed. Malignant teratoma (MTI, MTU, MTT), seminoma: Unilateral orchiectomy. Stage I: 4 courses standard chemotherapy. Stage II-IV: 2 courses standard chemotherapy, explorative laparatomy. During explorative laparatomy 3 different approaches are recommended: Modified lymphadenectomy, radical lymphadenectomy or removal of "bulky disease". In case of presence of vital tumor cells patients with teratoma receive "salvage therapy", patients with seminoma receive instead x-irradiation. If only differentiated teratoma cells are found in addition 2 courses of standard chemotherapy are administered. Standard chemotherapy consists of Vinblastine, Bleomycine and Cis-platinum, salvage therapy of VP 16, Ifosfamide and Cis-platinum.

Surgical intervention in patients with germinal testicular tumors is performed to obtain the exact tumor histology and to define the stage of disease. This can be achieved by inguinal orchiectomy and retroperitoneal exploration. In cases without metastases, a modified retroperitoneal lymphadenectomy (LA) can reduce operative morbidity. With regard to the juvenile age of the patients, protection of ejaculation is of particular importance. If retroperitoneal lymph node metastases are present radical LA should be performed. In case of infiltration of ureters or kidney pedicles a coincident of nephrectomy becomes necessary. Palliative primary surgery should be avoided by exact preoperative diagnosis. In patients presenting with primary inoperable tumors chemotherapy should be instituted prior to surgery. A more radical treatment is necessary if residual tumor has to be removed in a second look operation or after chemotherapy, respectively. Resection of metastases is particularly indicated in cases with mediastinal or pulmonary spread.

System N, a neutral amino acid transport system characterized in rat hepatocytes, shows significant changes in activity during the first 24 hr of primary culture (Weissbach, L., Handlogten, M.E., Christensen, H.N., and Kilberg, M.S. [1982] J. Biol. Chem. 257:12006-12011). Experiments presented in the present report demonstrate that during the first 12 hr of primary culture System N can be stimulated by individual amino acids in the culture medium by a cycloheximide-insensitive mechanism. This enhanced activity results from an elevation in the Vmax of the transport system, and the magnitude of the increase is related to the concentration of the amino acid in the culture medium. Nonsubstrates as well as substrates of System N are effective, and trans-stimulation does not appear to play a role in this phenomena. Transport by Systems ASC, Gly, and L is enhanced by the presence of amino acids in the culture medium, but these systems are significantly less sensitive than System N. The results suggest that amino acids act at a posttranslational step to activate System N activity.