De Novo Focal Glomerulosclerosis After Kidney Transplantation

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TRANSPLANTATION

compare with each study group and the controls. A significant, although modest, elevation of testosterone and similar depression of estradiol with elevated testosterone-to-estradiol ratios were seen in benign prostatic hyperplasia. No statistically significant associations were seen with prostatic cancer. 7 tables, 31 references James H. Nelson, III, M.D. Columbus, Ohio

Adenocarcinoid Tumor of Appendix Presenting as Unilateral Krukenberg Tumor

R. T. MILLER, H. SARIKAYA AND E. L. JENISON, Departments of Pathology, and Obstetrics and Gynecology (Gynecologic Oncology), Timken Mercy Medical Center, Canton and Northeastern Ohio Universities College of Medicine, Rootstown, Ohio

Inhibition of Macrophage- and Neutrophil-Mediated Cytotoxicity by Verapamil D. J. CAMERON AND J. A. MAJESKI, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina J. Surg. Oncol., 37: 5-9 (Jan.) 1988 The authors studied the slow calcium channel blocking agent, verapamil, for its effects on in vitro macrophage and neutrophilmediated cytotoxicity. The addition of verapamil to macrophage or neutrophil tumor suspensions resulted in marked inhibition of tumor cell killing. The effect seemed to be on macrophage effector and target cells, and on neutrophil effector cells. The mechanism of the inhibition is unknown. The authors speculate that verapamil may prevent close cell contact necessary to initiate cytotoxic reactions. 6 tables, 15 references James H. Nelson, III, M.D. Columbus, Ohio

J. Surg. Oncol., 37: 65-71 (Jan.) 1988 Krukenberg's tumor, described in 1896, was believed to be a mucin-producing fibrosarcoma of the ovary. Most of these tumors currently are believed to be signet ring cell mucinous adenocarcinoma of the ovary with a prominent stromal fibrous response. Most of these tumors are metastatic. The authors report a case (case 14 in the literature) of a carcinoid tumor of the appendix that presented initially as an ovarian tumor. The primary remained occult until a second-look operation 10 months later. They suggest that because the appendiceal primary may be small and easily missed, appendectomy should be done in all cases of Krukenberg tumors when a primary cannot be identified. 7 figures, 1 table, 32 references James H. Nelson, III, M.D. Columbus, Ohio

Presenting Symptoms Compression

of Neoplastic

Spinal

Cord

M. C. COPEMAN, Royal North Shore Hospital of Sydney, St. Leonardo, Australia J. Surg. Oncol., 37: 24-25 (Jan.) 1988 The case records of 28 patients with metastatic disease causing spinal cord compression were reviewed. Diagnosis was made at myelography and all patients had tissue confirmation at laminectomy. Only 1 patient had no symptoms. The common symptoms were back pain (68 per cent), bilateral leg weakness (61 per cent), urinary retention (36 per cent) and bilateral leg numbness (32 per cent). Twelve patients had known neoplasia. Of these patients 2 had spinal cord compression diagnosed within 1 week of onset of symptoms. In 93 per cent of the patients diagnosis was delayed for more than 1 week in the face of symptoms. Less common symptoms, such as ataxia and unilateral leg weakness or pain, were associated more commonly with delay in diagnosis. The author notes that familiarity with the wide range of symptoms associated with spinal cord compression will lead to more rapid diagnosis. 1 table, 4 references James H. Nelson, III, M.D. Columbus, Ohio

TRAUMA Perirenal Hematoma Following Judo Training S. FUJITA, M. KUSUNOKI, T. YAMAMURA AND J. UTSUNOMIYA, Second Department of Surgery, Hyogo College of Medicine, Hyogo, Japan N. Y. State J. Med., 88: 33-34 (Jan.) 1988 A 73-year-old retired policeman had a 30-year history of left flank pain with gradual worsening. The patient had practiced judo for about 50 years. Blood pressure was 140/90. Renal ultrasound showed a sonolucent mass 5 cm. in diameter and medial to the left kidney. Computerized tomography confirmed the mass, which was avascular on arteriography. Exploration showed a large (8 X 7 X 4 cm.) hematoma between the true capsule and the renal fascia. Convalescence was uneventful, and the patient has remained free of pain and normotensive. As with most martial arts injuries are inevitable. About 60 per cent of all skilled judo players in Japan complain of chronic lumbar pain. Judo nephropathy has been described consisting of microscopic hematuria and decreased glomerular filtration rate. The authors review the development of perirenal hematoma and underscore the chronic nature of the condition in this case. 2 figures, 10 references James H. Nelson, III, M.D. Columbus, Ohio

TRANSPLANTATION De Novo Focal Glomerulosclerosis After Kidney Transplantation A. C. WOOLLEY, M. E. ROSENBERG, B. A. BURKE AND K. A. NATH, Division of Nephrology, Department of Medicine, and Departments of Laboratory Medicine and Pathology, and Pediatrics, University of Minnesota, Minneapolis, Minnesota Amer. J. Med., 84: 310-314 (Feb.) 1988 A 44-year-old white man with adult polycystic disease and renal failure underwent an ABO-matched cadaveric renal allograft. The transplanted kidney was from a 6-year-old child

446

ANDROLOGY

and had 2 main renal arteries, 1 supplying the upper half and 1 the lower half of the kidney. The patient received the standard antirejection regimen of cyclosporine, azathioprine, prednisone and human antilymphocyte globulin. Hemodialysis was required for the first 3 weeks after transplantation and biopsy of the graft showed resolving acute tubular necrosis. At 10 months the creatinine level increased significantly. Renal ultrasound demonstrated that the kidney length had increased from 6 to 9 cm. Biopsy at this time showed glomeruli with segmental sclerosis and hyalinosis, adhesions and foam cells. The patient was rehospitalized 12 months postoperatively with hematemesis, peripheral edema and hypertension. A renal arteriogram showed occlusion of the upper artery. Renal biopsy demonstrated glomeruli that were segmentally sclerosed, with others showing global sclerosis and crescent changes. The patient had progressive renal failure and hemodialysis was begun. This case, in which focal and segmental glomerulosclerosis developed associated with systemic hypertension, proteinuria, progressive azotemia and graft hypertrophy despite the absence of other predisposing factors, supports the concept that renal hemodynamic changes associated with stimuli for renal hypertrophy cause progressive nephron damage. The implications of this for patients undergoing unilateral nephrectomy for malignant or benign processes, including donor nephrectomy, are noted. 2 figures, 16 references Mark J. Schacht, M.D. Chicago, Illinois

AND RO LOGY Role of Temperature in Regulation of Spermatogenesis and the Use of Heating as a Method for Contraception F. R. KANDEEL AND R. S. SWERDLOFF,

Division of Endocrinology, Department of Medicine, Harbor- University of California Los Angeles Medical Center, Torrance, California

Fertil. Steril., 49: 1-23 (Jan.) 1988 The authors present an extensive review of the data available to investigate and establish relationships among testicular temperature, sperm production and structure, and testicular morphology. They note that the studies have established the vulnerable nature of spermatogenesis to relatively small increases in the testicular temperature. They also note that other physical properties of electromagnetic and ultrasound energy have an additive or synergistic effect to that of heat, and may allow interference with spermatogenesis at minimal temperature elevations. The applicability of this to the field of contraception is discussed. However, they warn that many questions remain to be answered, including those concerning the appropriate dose and frequency of application, the long-term safety and the possibility of mutagenesis. 7 figures, 4 tables, 178 references Mark J. Schacht, M.D. Chicago, Illinois

Revised New Guidelines for the Use of Semen-Donor Insemination

DIVERSION Treatment of Iatrogenic Functional or Morphologic Bladder Loss

M.

ST6CKLE, J. W. THUROFF, H. RIEDMILLER, P. ALKEN AND R. HOHENFELLNER, Department of Urology, Medical School,

University of Mainz, Mainz, Federal Republic of Germany J. Ped. Surg., 23: 171-176 (Feb.) 1988 The authors present their experience with ileocecal cystoplasty (Mainz pouch) in children with functional or morphological loss of the bladder. Of the 6 patients 2 had intractable bladder fibrosis from repeated ureteroneocystostomy, 2 had bladder necrosis from injected chemicals (ether to rupture a Foley balloon and TRIS-buffer injected by mistake into an umbilical artery catheter), 1 lost the bladder during infant herniorrhaphy and 1 had undergone cystectomy for sarcoma. No serious complications could be attributed to the procedure. The authors believe that the Mainz technique is well suited for bladder replacement. 8 figures, 1 table, 11 references George F. Steinhardt, M.D. St. Louis, Missouri

Editorial comment. The Mainz pouch, incorporating detubularized sections of large and small bowel, has reliably produced a compliant urinary reservoir that can be anastomosed to the urethral stump when the sphincter is present, or that can be used in conjunction with either an artificial urinary sphincter or a continent catheterizable stoma. Essentially the same operation is used for bladder substitution, as illustrated in this study. Lowell R. King, M.D. Durham, North Carolina

AMERICAN FERTILITY SOCIETY,

Birmingham, Alabama

Fertil. Steril., 49: 211 (Feb.) 1988 To prevent transmission of the human immunodeficiency virus during donor semen insemination new guidelines have been proposed by the American Fertility Society. Fresh semen for donor insemination no longer should be used. All collected specimens should be frozen and stored for 180 days. The donor then should be re-tested and found still to be seronegative for human immunodeficiency virus before the specimen is used for insemination. Although some decrease in pregnancy rates may be noted with the use of frozen semen, the Society believes that this position is warranted in view of the fact that a newly infected semen donor may not become seropositive for 3 months or longer after infection. 1 reference Drago K. Montague, M.D. Cleveland, Ohio

The Endocrinology of V aricoceles R. W. HUDSON, Faculty of Medicine, Queen's University and the Kingston General Hospital, Kingston, Ontario, Canada

Fertil. Steril., 49: 199-208 (Feb.) 1988 This study of 56 men with varicocele and 12 normal controls is a followup of a previous report by the same author. Dynamic tests of the hypothalamic-pituitary-testicular axis were performed, and seminal plasma testosterone and dihydrotestosterone were measured. Oligospermic men with abnormal hormonal profiles responded favorably to correction of the varicocele. This study provides longer followup than the previous study and to date no oligospermic men with normal hormonal profiles