Pneumothorax and Hydrothorax Following Placement of Central Catheter

0022-534 7/0022-534 7/83/1283-0655$02.00/0 Vol.128, September

THE JOURNAL OF UROLOGY

Printed in U.S.A.

Copyright© 1982 by The Williams & Wilkins Co.

ABSTRACTS tibody against Klebsiella pneumoniae were identified in the serum cryoglobulin and in a renal biopsy eluate. The stool contained similar Klebsiella pneumoniae. It was postulated that the intestinal blind loop likewise was colonized heavily with the same organism, representing a continuous source of readily absorbable antigen. Renal function improved in this patient after treatment with methylprednisolone and chloramphenicol. This unusual complication of reversible renal failure occurring in patients treated with an intestinal bypass operation is contrasted with the irreversible changes caused by hyperoxaluria and renal parenchymal oxalate deposition after a similar operation for morbid obesity. J.D.S. 5 figures, 1 table, 31 references

INFECTIONS AND ANTIBIOTICS Urinary Tract Infections in Young Infants C.

M. GINSBURG AND G. H. McCRACKEN, JR., Department of Pediatrics, University of Texas Health Science Center, Southwestern Medical School, Dallas, Texas

Pediatrics, 69: 409-412 (Apr.) 1982 While it is recognized that characteristics of urinary tract infections in neonates differ markedly from those in older children the point of transition has not been defined. In this study the authors reviewed the clinical and laboratory features of 62 boys and 38 girls between 5 days and 8 months old who were hospitalized with the first known urinary tract infection. During the first 3 months of life male infants accounted for 75 per cent of the cases but from 3 to 8 months they accounted for only 11 per cent. Of possible significance in this regard is the observation that only 5 per cent of the male infants had been circumcised. Blood cultures were obtained from 91 patients and were positive in 20. Positive blood cultures were related inversely to age of patient and were uncommon after the infant was 9 weeks old. X-rays were obtained in 86 cases and were abnormal in 18. Abnormalities were encountered more commonly in girls than in boys. Escherichia coli was the most common organism cultured from the urine. None of the patients suffered meningitis and the response to therapy was prompt in all cases. T.D.A. 1 figure, 13 references

Editorial comment. This report parallels the pioneering studies of Winberg and suggests that sepsis in male neonates might be the best argument that can be made currently for neonatal circumcision. However, only a tiny proportion of male infants suffer urinary tract infections. Most neonates are uncircumcised, have normal urinary tracts and stay well after the infection is eradicated. On the other hand, there is a high incidence of urologic anomalies, particularly reflux, in female infants who become infected. For this reason all infants should be screened by a cystogram and an excretory urogram after a first infection. L.R.K. Immune Complex Glomerulonephritis and Dermal Vasculitis Following Intestinal Bypass for Morbid Obesity C.

A. KIMCHI, T. A. DEPNER AND D. Department of Pathology, Sutter Memorial Hospital and Sections of Gastroenterology and Nephrology, Department of Medicine, University of California, Davis Medical Center, Sacramento, California N.

Routine Subcultures Shown to be Unnecessary in Radiometric Detection of Bacteremia Using Three Media

C. L. STRAND, Department of Pathology, Crawford W. Long Memorial Hospital of Emory University, Atlanta, Georgia Amer. J. Clin. Path., 77: 328-332 (Mar.) 1982 The goal of this study was to determine whether radiometric means of detecting bacteremia are sensitive enough to obviate the need for routine subcultures to eliminate the possibility of the presence of bacteria not growing in quantities sufficient to be detected on radiometry. Radiometric assays are done by adding 14carbon labeled substrate to the blood culture bottle and then measuring the radioactively labeled isotope of carbon dioxide generated by the bacterial growth. The author reviewed 6,208 blood cultures and found 454 cases with microbial recovery. Radiometric assay detected the microbial growth in all except 1 sample in which Staphylococcus epidermidis was detected 48 hours earlier by blind subculture. The author concludes that the sensitivity of radiometric detection of bacteremia makes routine subcultures of blood culture specimens unnecessary. If this is the case it will reduce the cost of performing blood cultures. C.L.P. 3 tables, 6 references Pneumothorax and Hydrothorax Following Placement of Central Catheter L.

GAMBLE,

CHRISTENSEN,

Amer. J. Clin. Path., 77: 347-352 (Mar.) 1982 Recent reports suggest that glomerulonephritis caused by the deposition of cold precipitable bacterial antigen-antibacterial antibody complexes may occur in patients treated with intestinal bypass for morbid obesity. The mechanism may be related to the systemic absorption of intestinal bacterial antigens that lead to the formation of circulating immune complexes. The authors describe a 32-year-old man who had mixed cryoglobulinemia, arthritis, dermal vasculitis and immune-complex-induced glomerulonephritis 4 years after jejunoileal bypass for morbid obesity. Anti-immunoglobulin G antibody and an-

J. NEWMAN, J. A. SANFILIPPO, M. s. HALATA AND W.-Y. Yu, Department of Pediatrics, New York Medical College, Valhalla, New York

N. Y. State J. Med., 82: 341-343 (Mar.) 1982 The complications of percutaneous subclavian catheter insertion are well known (malposition, pneumothorax, hydrothorax, thrombophlebitis, brachial plexus injury, carotid artery laceration, mediastinal hematoma and chest wall abscess). The authors describe a 17-year-old patient with granulomatous colitis in exacerbation. A left subclavian catheter was inserted for total parenteral nutrition. Left pneumothorax resulted and dye injection produced extravasation, although the catheter tip was believed to be in the superior vena cava. A left chest tube was inserted and hyperalimentation was begun. On removal of the chest tube 48 hours later the patient had simultaneous right hydrothorax and recurrent left pneumothorax. Repeat dye injection again showed extravasation. A chest tube was reinserted and the subclavian line was removed. The right side produced 655

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ONCOLOGY AND CHEMOTHERAPY

1,600 cc hyperalimentation solution. The authors believe that catheter rigidity resulted in the erosion of the superior vena cava. They indicate that this is a previously unreported complication. 1 figure, 13 references

Abstracter's comment. The authors fail to explain the extravasation seen on dye injection after the initial catheter insertion. One wonders why the catheter was not removed then and later reinserted. The ensuing complications might have been obviated. J.H.N.

ONCOLOGY AND CHEMOTHERAPY

tients had Wilms tumor but normal detailed chromosome analyses. These cases demonstrate 3 points. 1) The aniridia-Wilms tumor association is not always caused by a microscopic or submicroscopic detectable chromosome deletion (llp13). 2) The aniridia-Wilms tumor association needs to be expanded to include a wider variety of iris dysplasias (partial aniridia). Children with Wilms tumor may need careful ophthalmologic examination. 3) Aniridia has a genetic heterogeneity and sporadic aniridia/iris dysplasia appears to be associated with an increased risk for Wilms tumor regardless of negative genetic data. H.M.S. 2 figures, 17 references

An EORTC Phase II Study of Methyl-Glyoxal Bis-Guanylhydrozone in Advanced Renal Cell Cancer

Childhood Cancer in Offspring of Two Wilms Tumor Survivors

J. A.

A.

HUININK, M. DEPAUW AND

F. KANTOR, F. P. LI, J. F. FRAUMENI, JR., M. G. McCREA CURNEN AND J. T. FLANNERY, Environmental and Clinical

matology, Leeds General Infirmary, Leeds United Kingdom, Ospedale Di Circolo E Fondazione E. eS. Macchi, Varese, Norwegian Radium Hospital, Oslo, Norway, Artoni van Leewen-hoekhuis Amsterdam, The Netherlands, EORTC Data Centre, Brussels, Belgium and Academisch Ziekenhuis der Urije Universiteit, Amsterdam, The Netherlands

Epidemiology Branches, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, Connecticut Cancer Epidemiology Unit, New Haven, Connecticut, Columbia University School of Public Health, New York, New York and Connecticut Tumor Registry, Hartford, Connecticut

CHILD,

A. V. BoNo, S. D. FossA, W.W. TEN BoKKEL G. STOTER. Department of Hae-

Eur. J. Cancer, 18: 85-88 (Jan.) 1982

Med. Ped. Oncol., 10: 85-89, 1982

This investigation is a phase II study of methyl-glyoxal bisguanylhydrozone by the Genitourinary Tract Cooperative Group of the European Organization for Research Treatment of Cancer (EORTC) in patients with disseminated renal cancer. These investigators have indicated the lack of any reliable and effective therapy for disseminated renal cell carcinoma. Although there were 45 patients in the study only 30 were evaluable for response. The indicator lesions were predominantly measurable pulmonary metastases. These 30 patients received 500 mg./m. 2 methyl-glyoxal bis-guanylhydrozone weekly for at least 4 treatment cycles. In 3 patients (10 per cent) partial remission was achieved, in 11 the disease was considered stable and in 16 there was progression. Toxicity was evaluated in 40 patients, including nausea, vomiting, neuropathy, myopathy, myologia and mucositis. These investigators concluded that methyl-glyoxal bis-guanylhydrozone has no effect on disseminated renal cell cancer because of its minor activity and appreciable toxicity. N.J. 15 references

A search was made for cancer among offsprings and siblings of 149 children reported with Wilms tumor from Connecticut between 1935 and 1973. Of the 149 children 5 (all with unilateral Wilms tumor) had a sibling who suffered cancer before he was 25 years old (2 Wilms tumors, 2 Hodgkin's disease and 1 testicular seminoma). This rate is higher than expected and supports the concept of a genetic contribution to neoplasia. Of the 149 Wilms tumor patients 56 were well and 25 were ~18 years old. Of these 56 patients 2 (with unilateral Wilms tumor) had offsprings who had cancer. A daughter of 1 patient had rhabdomyosarcoma of the nasopharynx. The other case was a daughter who had nodular sclerosis type Hodgkin's disease. No offspring with Wilms tumor was reported. The authors indicate that the nature of their review makes under reporting likely. If the Knudson and Strong hypothesis that bilateral or familial Wilms tumors are hereditary through an autosomal dominant gene the risk of Wilms tumor in offsprings should be 32 per cent (incomplete gene penetrance). For unilateral (primary nonfamilial) Wilms tumor the risk of this tumor arising in the offspring has been estimated to be 3 to 5 per cent. H.M.S. 1 figure, 1 table, 18 references

Wilms Tumor With Aniridia/lris Dysplasia and Apparently Normal Chromosomes

v.

D. J. Neuroblastoma in a Pair of Identical Twins Research Cytogenetics Laboratory, Cullen Eye Institute, and Departments of A. F. MANCINI, P. RosITo, G. FALDELLA, L. SERRA, R. Medicine and Pediatrics, Baylor College of Medicine, M.D. VALLICELLI, V. VECCHI, F. VIVARELLI AND G. PAOLUCCI, Anderson Hospital and Tumor Institute, and Graduate Departments of Pediatrics, Neonatology, and Pathology, School of Biomedical Sciences, University of Texas Health University of Bologna, Bologna, Italy Sciences Center, and University of California School of Med. Ped. Oncol., 10: 45-51, 1982 Medicine, San Francisco, California The authors describe a pair of identical twins with neuroJ. Ped., 100: 574-577 (Apr.) 1982 blastoma. One twin was stillborn and at autopsy had a left The aniridia-Wilms tumor association has been attributed to adrenal neuroblastoma with widespread metastases in the liver. deletions on the short arm of the 11th chromosome in the llp13 The other twin had a normal physical examination, bone marband. The authors report 2 cases, 1 with sporadic isolated row aspiration, urinary vanillyl mandelic acid and homovanillic aniridia and the other with bilateral irregular iris hypoplasia, acid, as well as abdominal ultrasound. However, when he was mild mental retardation and orthopedic anomalies. Both pa- 2 months old an enlarged liver and anemia were detected. M.

RICCARDI, H. M. HITTNER, L. C. STRONG,

FERNBACH,

R.

LEBO AND

R. E.

FERRELL,