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Background and Study Aims: N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding, The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates. Patients and Methods: One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, acid 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone, Histoacryl was injected intravariceally during the first session in the Group A patients. Results: A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05), The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05). Conclusions: The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.

We report a case of renal cell carcinoma with an extensive intraperitoneal metastasis at the time of diagnosis. This type of metastasis is very rare for renal cell carcinoma and is identified in only 1 % of the metastases at autopsy. The findings of computed tomography are presented.

Specimens from 75 cases of prostatic adenocarcinoma of different M.D. Anderson degrees of malignancy were stained immunohistochemically for neuron-specific enolase (NSE), prostatic specific antigen (PSA) and prostatic acid phosphatase (PAP). None of these tumors presented on hematoxylineosin sections any features suggesting neuroendocrine differentiation; nevertheless, 18.7% of the tumors were at least focally NSE positive. Because of the synchronous antigenic expression of the NSE-positive cells to PSA and PAP, the authors suggest that prostatic exocrine and neuroendocrine cells derive from a common precursor stem cell. The possibility of a more aggressive biological behavior of these tumors in comparison to the conventional carcinomas is discussed. The probable clinical necessity for a combined therapeutic approach is also investigated.

Stenosis of the mid-portion of the right ureter and moderate hydronephrosis of the right kidney was seen on the intravenous pyelography of a 60-year-old patient consulting for sudden onset pain in the right inguinal region. Confirmation was obtained with retrograde urography and abdominal computed tomography. Right nephroureterectomy was performed. The pathology examination revealed characteristic features of amylosis located solely at the narrowing of the ureter. Isolated amylosis of the ureter is rare and difficult to diagnose.

Tumor cells and urine-voided cells from patients with invasive bladder carcinoma as well as from healthy patients were examined cytologically, ultrastructurally and immunocytochemically. The ultrastructure of tumor cells showed an abundant, dilated, rough endoplasmic reticulum in the form of membrane-bound vacuoles full of granular to fibrillar material located perinuclearly and/or paranuclearly. Some cells exhibited enlarged modified lysosomes containing sparce flocculent and particulate precipitate. Papanicolaou staining of these cells showed two basophilic cytoplasmic textures, one green glossy-patchy, perinuclearly and/or paranuclearly, well segregated from the other texture of peripheral hematoxylinophilic foamy cytoplasm, comparable to the cytologic features of cell cultures originating in invasive bladder carcinoma. PAS diastase showed double distribution and texture of the perinuclear glycosaminoglycans, a glossy accumulated mass and large granules. Glycosaminoglycan sacs similar to those of cell cultures were also present in tumor-dispersed cells. There was a nonspecific binding of antisera against lysozyme, human chorionic gonadotropin and alpha 1-trypsin in normal and tumor cells. Tumor cells and tissues were positive for alpha 1-chymotrypsin distributed perinuclearly and in large spheres. Normal cells lacked the above characteristics. The results indicate that it is feasible to use the aforementioned characteristics in conjunction with the existing bladder-cytologic criteria for malignancy as markers in urothelial cancer with regard to prognosis of superficial tumors with high malignant potential.

Thirty-six transvesical or transurethral prostatectomy cases were selected from the histopathology files of the Laiko General Hospital. Among the 36 cases, there were 10 with benign prostatic hyperplasia (8 patients having distinct areas of adenosis) and 26 cases of prostatic adenocarcinoma (6 grade I, 13 grades II and III and 7 grade IV carcinomas). From each case, silver-binding nucleolar organizer regions (AgNORs) have been counted in sections of routinely processed paraffin-embedded tissue blocks. The mean AgNOR count per case was calculated. For the cases of prostatic hyperplasia, the mean AgNOR count was found to be 2.95 +/- 0.42, for adenosis 3.45 +/- 0.56, for grade I adenocarcinoma 4.97 +/- 0.74, for grades II and III 7.31 +/- 0.81 and for grade IV adenocarcinomas 11.41 +/- 1.68. This difference in the mean AgNOR count was found to be of statistical significance (p < 0.001) between adenosis and grade I adenocarcinomas and between grade II and III and grade IV adenocarcinomas. It appears that AgNOR counting may prove to be of benefit in differentiating between some benign and malignant prostatic lesions and that it might provide information concerning the biological behavior of prostatic adenocarcinomas.

Twenty-eight cases of prostatic adenocarcinomas have been selected and the mean argyrophil nucleolar organizer region (AgNOR) count for each case was evaluated. Nine of these tumors were of high, 13 of median and 6 of low differentiation. It was found that as the tumors became less differentiated, the AgNOR count increased (p less than 0.001). Stage of the disease, serum prostate-specific antigen (PSA) value, and DNA ploidy of all these cases have been examined as well but no statistically significant correlation among these three parameters and the AgNOR count was found.

Thirty-six transvesical or transurethral prostatectomy cases were selected from the histopathology files of the Laiko General Hospital. Among the 36 cases, there were 10 with benign prostatic hyperplasia (8 patients having distinct areas of adenosis) and 26 cases of prostatic adenocarcinoma (6 grade I, 13 grades II and III and 7 grade IV carcinomas). From each case, silver-binding nucleolar organizer regions (AgNORs) have been counted in sections of routinely processed paraffin-embedded tissue blocks. The mean AgNOR count per case was calculated. For the cases of prostatic hyperplasia, the mean AgNOR count was found to be 2.95 +/- 0.42, for adenosis 3.45 +/- 0.56, for grade I adenocarcinoma 4.97 +/- 0.74, for grades II and III 7.31 +/- 0.81 and for grade IV adenocarcinomas 11.41 +/- 1.68. This difference in the mean AgNOR count was found to be of statistical significance (p0.001) between adenosis and grade I adenocarcinomas and between grade II and III and grade IV adenocarcinomas. It appears that AgNOR counting may prove to be of benefit in differentiating between some benign and malignant prostatic lesions and that it might provide information concerning the biological behavior of prostatic adenocarcinomas.

One thousand patients with renal stones up to 3 cm in diameter were divided equally into 2 groups matched for age, sex and stone size. One group was treated on the Dornier HM3 lithotriptor and the other on the EDAP LT01. The results showed that for stones less than 1 cm both lithotriptors were equally effective, with a stone-free rate of 87.5% for the Dornier and 90.4% for the EDAP at 3 months. The success rate fell more steeply for the EDAP machine, however, to become 77.2 and 42.5% respectively as the stone size increased to 3 cm. Treatment time was longer on the EDAP lithotriptor and more sessions were required but patients preferred it to the Dornier. Running costs per patient were higher on the EDAP.

Myelolipoma of the adrenal gland is an unusual, benign tumour which is composed of mature adipose tissue and hematopoietic elements, similar to those of bone marrow. The tumour is hormonally inactive and unilateral although four cases in which the tumour has been found bilaterally have been reported. Extra adrenal myelolipoma has also been reported in the kidney, the liver and the presacral area. We present the case of an asymptomatic adrenal myelolipoma in a 68-year-old man, which was surgically removed.

A total of 150 patients presenting with stone in the middle iliac ureter were treated with extracorporeal shock wave lithotripsy using a Dornier HM-4 lithotriptor. For adequate radiological stone visualization and excellent fragmentation, the prone position was used in all patients. In 45 patients (30%) an ureteral stent was placed before treatment. The overall success rate was 82% (123 of 150 patients). All patients were treated on an outpatient basis without anesthesia.

To our knowledge we report the first case of retroperitoneal angiomyolipoma located at the left ureterovesical junction associated with ipsilateral renal agenesis. Radiologically, the mass had the characteristics of a cystic soft tissue tumor. Final diagnosis was determined by histopathological examination, which revealed the specific characteristics of angiomyolipoma. The tumor is theorized to be a result of developmental malformation of fetal mesenchymal elements along the ureteral bud during fetal development since it was associated with ipsilateral renal agenesis.

The SNR excursions associated with power transients in chains of EDFAs contribute to the signal transmission penalty during power fluctuations in WDM optical systems. Analytical formulas that associate the SNR excursion with the power excursion and the amplifier number at the beginning and the end of the transient period are derived for a chain of gain equalised EDFAs.

Ten primary cultures from invasive urothelial carcinomas were studied by light and electron microscopy. In all cultures, cells with accumulations of glycosaminoglycans were observed. Long membrane extensions with accumulations of glycosaminoglycans invaded neighboring cells and formed an extracellular matrix as well. The extracellular matrix inhibited cell proliferation and enhanced tumor nodule formation.

A 33-year-old woman was admitted to our department with a palpable right flank mass of considerable size. Renal cell carcinoma was the diagnosis made by CT scan and MRI. When the tumor was excised, histology revealed an angiomyolipoma. The preoperative diagnostic error of MRI as well as CT scan is discussed.

The symptomatology of testicular torsion was atypical in 16 patients among the 40 that we treated. The occurrence of fever together with the torsion (8 cases), the existence of intense local inflammatory signs (16 cases), its occurrence in adults (23 cases), ectopic testicle (2 cases), and the possibility of a traumatism (5 cases) are misleading and may delay its urgent surgical treatment. In most cases, testicular torsion forms a characteristic clinical picture with easy diagnosis, requiring most urgent operation. There are, however, cases where symptomatology is atypical and deceptive forms delay recognition of the torsion, leading to ischaemic necrosis.

Opening the bladder via the perineum in order to remove a bladder stone was practised by the ancient Greek surgeons in very early times, probably from the days of Homer. The technique of lithotomy was described for the first time by Celsus in the first century AD and has come to be known as the lesser operation or 'apparatus parvus', so called because only to instruments are needed for it, a knife and a hook. Two fingers of the surgeon's left hand were introduced into the patient's rectum while an assistant pressed on the lower abdomen to encourage descent of the stone near the neck of the bladder. A slightly curved incision was made in the skin near the anus and a second transverse incision was made through or immediately above the prostate, opening the bladder neck. The calculus was extracted from the wound by the fingers or by a hook. This ancient method of lithotomy as described by Celsus was the only one performed until the middle of the 16th century, and many surgeons advised the apparatus parvus as the operation of choice in young patients until the middle of the 18th century.

The authors report the first results of the use of mercaptopropionyl-glycine (M.P.G.) in the solubilising and preventive treatment of cystine lithiasis. This substance results in the formation of a soluble cystine M.P.G. complex. It increases the solubility of cystine much more than D-penicillinamine. Twenty one cases of cystinuric cystine lithiasis were treated in this way, combined with forced diuresis, alkalinisation of the urine and uricolytic treatment. In 4 of their 21 patients, calculi disappeared completely, whilst in another 3 they decreased in size. Recurrence of lithiasis was avoided in 20 patients out of 21. These impressive results are similar to those in the brief literature concerned with the substance. Toxicity is virtually nil and its efficacy make this the drug par excellence for cystine lithiasis.

The authors discuss the radiological signs in 18 patients with an adrenal tumour. 7 of them had a Cushing's syndrome, 10 others a phaechromocytoma and the last had primary hyperaldosteronism. The diagnosis was made from the history, the clinical picture, hormone estimations and pharmacodynamic tests, whilts in the majority of cases the tumour was localised by radiodiagnosis. In all cases, there was hypertension, permanent in tumours of the adrenal cortex, paroxysmal or permanent in the cases of pheochromocytomas. We emphasise the importance of retro-pneumoperitoneum, as the radiological investigation of choice, in the localisation of adrenal tumours, especially pheochromocytomas, and in Cushing's syndrome. In cases of pheochromocytoma, one should follow carefully the blood pressure, during special radiological investigations, in view of the danger of a sudden rise or fall in blood pressure, the first is treated with phentolamine, the second with noradrenaline solution. Finally, a scan using I 131 19-iodocholesterol may be valuable in diagnosis and localisation of adrenal tumours; it has in particular given very encouraging results in the differential diagnosis of adrenal tumours with the clinical presentation of Cushing's disease.

Die prostatische Druse stellt den Hauptort der Zinkkonzentration beim Menschen dar. Daraus resultiert auch eine verhaltnismasig hohe Konzentration von Zink im Spermaplasma. Laut Arbeiten von Halsted und Smith bewegt sich der Zn-Spiegel im Blut zwischen 75 und 115 μg/100 ml, wahrend die Normwerte im Ejakulat mit 150 bis 300 μg/ml weit hoher liegen (Tabelle 1). Tabelle 1 Im Blutserum 75–115 μg/ml Zn-Konzentration Im Ejakulat 150–300 μg/ml Erste Spermafraktion 294 μg/ml Zweite Spermafraktion 44 μg/ml Nach Linholmer und Eliason ist diese Konzentration viel hoher in der ersten (294 μg/ml) als in der zweiten (44 μg/ml) Fraktion des Ejakulats. Diese Tatsache hat viele dazu bewogen, Vergleiche zwischen verschiedenen Spermiogrammtypen und dem Verhalten von Zink im Spermaplasma zu ziehen.

In 12 of 21 cystinuric patients, the components of cystine stones, either previously passed or removed at surgery, were studied by X-ray diffractometry and chemical analysis. The results of diffractometry suggested that, in addition to cystine, the stones contained sodium urate and ammonium magnesium orthophosphate hydrate, although chemical analysis was negative for these components. The role of uric acid in cystinuria is discussed. Eur Urol

Priapism, a persistent painful erection of the penis, is treated by conservative or operative measures. Corpus cavernosography is the only radiological method for the objective assessment of the efficacy of operation. A case of priapism was treated surgically, using a unilateral corpus cavernosum-saphenous vein shunt. The immediate and the late results were investigated by cavernosograms. A 26-year-old man was admitted to the Urology Clinic of the University of Athens for a persistent painful erection of the penis. His symptom had started 11 days before and was not related to sexual stimulation or desire.

The levels of Acid and Alkaline DNases were measured in the serum of patients with: (a) Cancer of the Genitourinary Tract (confirmed by biopsy), (b) with inflammatory diseases and non-malignant tumours of the Genitourinary tract, (c) healthy blood donors. In the first group the results showed that the Acid DNase level was raised in 62% and Alkaline DNase in 43%. In the second group acid DNase was increased in 30% and Alkaline DNase in 13%. In the third group Acid and Alkaline DNase levels were normal. These results suggest that the measurement of Acid and Alkaline DNases could be considered as malignant diseases markers, in spite of false positive and false negative results in some cases.

beta 2 Microglobulin is a low molecular weight protein synthesised by lymphocytes and neoplastic cells. The authors measured levels of this substance in the plasma of 40 patients with carcinoma of the bladder and normal renal function. 26 subjects were used as controls. Plasma levels were markedly higher in the bladder carcinoma sufferers than in the normal controls. Levels were also higher in invasive carcinomas than in superficial lesions. beta 2 microglobulin may therefore not be considered to be a specific indicator of carcinoma of the bladder but rather as a factor offering the possibility of measurement of the secretory activity of tumour cells.

The "Urocystin Test" has been used as a screening procedure for the diagnosis of the incidence of cystinuria in Ioannina District (Northwest Greece). From the 210 investigated urine samples, eight were positive and four of them were also L-cystine stone formers. All positive cases belong to two cystinuric families. The pedigree in village "Kato-Lapsista" is a genetic type of a "completely recessive cystinuria" while the other one in "Marmara" is the type of an "incompletely recessive cystinuria". All patients with L-cystine urolithiasis, except one child, were treated with the drug Thiola. Urol Res

We report a case of lipomatosis of the renal hilus which presented with macroscopic painless haematuria. The appearance of the pyelocalyceal system on the intravenous urogram set the diagnosis of renal carcinoma, a diagnosis that both ultrasound and computed tomography did not refute. Final diagnosis was established histologically.

Zystinsteine findet man bei etwa 2% der erwachsenen und bei 6–7,5% der minderjahrigen Steinkranken.