The Association of Aniridia and Wilms’ Tumor: Methods of Surveillance and Diagnosis

0022-534 7/83/1306-1248$02.00 Vol. 130, December

THE JOURNAL OF UROLOGY

Printed in U.S.A.

Copyright © 1983 by The Williams & Wilkins Co.

ABSTRACTS INFECTIONS AND ANTIBIOTICS The Condom Catheter: Urinary Tract Infection and Other Complications E.T. JOHNSON, Department of Medicine, Section of Intermediate Medicine, Veterans Administration Medical Center, Tuskegee, Alabama South. Med. J., 76: 579-582 (May) 1983 The extended care hospital at Tuskegee Veterans Administration Medical Center comprises 3 floors caring for approximately 250 patients. Most of the patients were elderly male veterans with a variety of common geriatric diseases. Each floor or unit is made up of wards housing ;;;;;8 patients, many of whom require bladder drainage systems, such as the indwelling Foley catheter, suprapubic catheter or condom external system. It generally has been accepted that a condom catheter drainage system is a beneficial substitute for an indwelling Foley catheter in many instances of urinary incontinence without obstructive uropathy. Since the indwelling catheter leads regularly to bacteriuria and, often, urinary tract infections its routine use is to be condemned. Direct bladder infection from condom use has not been reported in long-term patient care. A retrospective study of 64 geriatric patients on an extended care unit suggested strongly that long-term use of a condom catheter drainage system (mean use 35 months) was associated regularly with urinary tract infection. Common nosocomial pathogens were found, particularly Proteus and Providencia. The condom catheter drainage system also was associated with significant penile complications. It is hoped that these hazards can be minimized by careful application and monitoring of the condom catheter drainage system. G. P. M. 3 figures, 5 tables, 11 references

A Scanning Electron Microscopic Study of Urine Droppers and Urine Collecting Systems T. J. MARRIE AND J. W. COSTERTON, Departments of Medicine and Microbiology, Dalhousie University and the Victoria General Hospital, Halifax, Nova Scotia and the Department of Biology, the University of Calgary, Alberta, Canada Arch. Intern. Med., 143: 1135-1141 (June) 1983

ther studies are warranted to determine whether impregnation of urinary collecting systems with material that would dissolve this polysaccharide matrix or block its adhesion might be effective in delaying infection of the catheterized urinary tract. C.E.M. 5 figures, 21 references

Reduction by ICRF-187 of Acute Daunorubicin Toxicity in Syrian Golden Hamsters E. H. HERMAN, A. N. EL-HAGE, V. J. FERRANS AND D. T. WITIAK, Division of Drug Biology, Food and Drug Administration, Washington, D. C., Pathology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland and College of Pharmacy, Ohio State University, Columbus, Ohio Res. Comm. Chem. Path. Pharm., 40: 217-231 (May) 1983 ICRF-187, a derivative of ethylenediaminetetraacetic acid, has been shown to reduce the lethal effects of high doses of daunorubicin in Syrian hamsters. The authors studied this compound to elucidate further the mechanisms involved. It was found that animals pre-treated with 100 mg./kg. ICRF-187 were able to regain their initial weight loss and increase their body weight above the control level, while no other groups of animals given lesser doses of ICRF-187 did so. Additionally, optimal survival was noted when the ICRF-187 was given from 3 hours before to 3 hours after administration of daunorubicin. Histologic studies of sacrificed animals suggest strongly that the lethal effects of high doses of daunorubicin in the hamster may be owing to gastrointestinal toxicity. G. W. K. 4 figures, 14 references

ONCOLOGY AND CHEMOTHERAPY The Association of Aniridia and Wilms' Tumor: Methods of Surveillance and Diagnosis N. PALMER AND A. E. EVANS, Children's Cancer Research Center, The Children's Hospital, Philadelphia, Pennsylvania Med. Ped. Oncol., 11: 73-75, 1983

The authors reviewed the records of 1,287 patients entered One glass and 1 plastic dropper, from which Serratia marces- in the National Wilms Tumor Studies 1 and 2 between 1969 cens and other organisms were isolated, were studied as well as and 1978, and found 13 cases of aniridia. Of these patients 10 urine bags from 5 patients with catheter-acquired bacteriuria. had stage 1 tumors. Details of the pre-diagnostic studies were A 2 cm. length of plastic tubing and a 2 x 1 cm. piece of plastic available in 9 patients who had been examined regularly by were examined by scanning electron microscopy. Adjacent areas excretory urography (IVP) at intervals of 3 to 12 months before from the samples were cultured. There was extensive microbial the discovery ofWilms tumor but in only 1 was the unsuspected colonization on the surface of urine droppers and urine collect- Wilms tumor detected by these means. Of the remaining 8 ing systems, as well as an extensive background matrix and patients the tumor was discovered by palpation in 6 and was fibrous strands interconnecting the bacteria. The urine bags suspected because of hematuria in 2. Based on these findings also were colonized heavily (bacteria were present in layers). the authors suggest that the most effective method of followup The amorphous deposits on the surface of many of the bacteria for these children and others at risk consists of an initial represent the bacterial glycocalyx. In previous studies the au- complete physical examination, including careful palpation of thors have shown that bacteria adhere to each other and to the the abdomen, and a search for other congenital anomalies, surface of urinary epithelial cells by a fibrous matrix positive urinalysis, an IVP to determine the structure and function of for ruthenium red. The presence of such a mechanism of both kidneys, and abdominal ultrasound. Thereafter, they recadhesion of bacteria to solid surfaces suggests that this ruth- ommend that a physical examination, urinalysis and abdominal enium red matrix probably is bacterial exopolysaccharide. Fur- ultrasound be performed every 3 months until the child is 2 1248

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ONCOLOGY AND CHEMOTHERAPY

years old and every 6 months thereafter until the child is 4 years old. P. R. R. 10 references

Editorial comment. The authors compared examinations that were used in the surveillance of children with aniridia who later suffered Wilms tumor. Surprisingly, an IVP detected an asymptomatic mass in only 1 of 9 children. The authors propose more frequent use of ultrasonography to disclose an asymptomatic and impalpable renal mass. M. M. Renal Cell Carcinoma in Children R. B. RANEY, JR., N. PALMER, W.W. SUTOW, E. BAUM AND

Division of Oncology, Children's Hospital, Philadelphia, Pennsylvania, Division of Pathology, Children's Hospital, Columbus, Ohio, Divisions of Pediatrics and Pathology, M. D. Anderson Hospital, Houston, Texas, and Division of Hematology-Oncology, Children's Memorial Hospital, Chicago, Illinois A. AYALA,

Med. Ped. Oncol., 11: 91-98, 1983 The authors have outlined the clinical details and treatment results in 20 children with renal cell carcinoma at 4 pediatric oncology treatment centers. To facilitate comparison between the renal cell carcinoma study patients and children with Wilms tumor the authors followed the grouping system used in the Second National Wilms Tumor study to stage the extent of tumor at diagnosis. Based on the data of the study the authors conclude that 1) renal cell carcinoma in children is similar to its counterpart in adults, 2) renal cell carcinoma has a worse prognosis than Wilms tumor except for the earlier stage, 3) nephrectomy alone is adequate treatment for group 1 renal cell carcinoma and 4) young age (<11 years old) may be prognostically favorable. P. R. R. 2 figures, 2 tables, 30 references

Editorial comment. The authors combined the findings in 20 children with renal cell carcinoma observed at 4 pediatric treatment centers and noted that the disease in children appears to mimick that in adults. The primary treatment mode is surgical excision. Radiation and chemotherapy are adjuncts, especially when curative surgery cannot be performed. Preoperative embolization may be worthwhile for children with large tumors, when complete removal is not believed feasible preoperatively. M. M. Carcinoma of the Urinary Bladder Category T 3 NxMo Treated by the Combination of Radium Implant and External Irradiation: Second Report

B.

VANDERWERF-MESSING, R. S. MENON AND w. C. J. HOP, Departments of Radiotherapy, Pathology and Statistics, Rotterdam Radiotherapy Institute, Rotterdam, The Netherlands

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and 2 deaths of progressive renal insufficiency. From their analysis it is evident that the degree of differentiation, vascular invasion and perivesical infiltration results in an unfavorable prognosis. The authors state that prognosis with this treatment protocol is at least as good as the Rotterdam experience with preoperative irradiation followed by simple cystectomy. H. D. P.

2 figures, 1 table, 3 references

Cancer of the Urinary Bladder Category T 2 , T 3 (NxMo) Treated by Interstitial Radium Implant: Second Report B. VANDERWERF-MESSING, R. MENON AND W. C. J. HOP, Rotterdam Radiotherapy Institute and Erasmus University, Rotterdam, The Netherlands

Int. J. Rad. Oncol. Biol. Phys., 9: 481-485 (Apr.) 1983 A total of 328 patients with stage T2 and 63 with stage T3 bladder tumors not >5 cm. in diameter forms the basis of this report. In each case there was no evidence of nodal involvement or metastases. All patients were treated with 3 courses of external radiation to the pelvic midline (each treatment delivering 3.5 Gy) followed by a radium implant. Over-all, 5-year survival for the stage T2 category was 56 per cent and for the T3 category it was 39 per cent, while the 10-year survival rates were 37 and 13 per cent, respectively. Poor prognostic factors were > 1 transurethral resection before treatment, an abnormal excretory urogram and poorly differentiated tumors. Patients with stage T3 disease who did not have any of these unfavorable factors had a prognosis similar to those with T2 cancer in whom the incidence of these unfavorable factors was less. The authors conclude that survival after this form of treatment is better for patients with stage T2 disease (in the absence of any abnormal prognostic factors) than with any other treatment modality. In patients with T2 cancer and poor prognostic factors and those with T3 disease the authors already have altered their treatment to provide a total of 40 Gy external radiation followed by a reduced dose of radium implantation (radium 55 per cent). D. K. M. 2 figures, 5 tables, 14 references

Presumptive Downstaging From Preoperative Irradiation for Bladder Cancer as Determined by Flow Cytometry: Preliminary Report F. A. KLEIN, w. F. WHITMORE, JR., R. M. WOLF, H. w. HERR, P. C. SOGANI, L. STAIANO-COICO AND M. R. MELAMED, Urology Service of the Department of Surgery and the Cytology Service of the Department of Pathology, Memorial Sloan Kettering Cancer Center, Cornell University Medical College, New York, New York

Int. J. Rad. Oncol. Biol. Phys., 9: 177-180 (Feb.) 1983

Int. J. Rad. Oncol. Biol. Phys., 9: 487-491 (Apr.) 1983

Forty-one patients with bladder cancer (T3NxMO) not >5 cm. in diameter were treated by 3 X 350 rad external radiation, radium implantation at reduced dose and an additional 3,000 rad external radiation. All 41 patients have been followed for ~1 year and the 5-year uncorrected actuarial survival was 57 per cent. Causes of death were intercurrent disease without evidence of bladder cancer (5), bladder cancer (8) and complications (2). Significant complications were seen in 8 patients (19.5 per cent) and include local necrosis, stone formation, ileus

A total of 28 patients with incompletely resected clinical stage T3 grade II or III bladder tumors forms the basis of this report. The patients were treated with 2,000 rad external radiation delivered to the whole pelvis in 5 days followed by cystectomy 1 to 14 days later. Before and after radiation, barbotage specimens were obtained from the bladder and subjected to flow cytometry. Before radiation all patients had positive flow cytometry specimens with an aneuploid stemline. Post-radiation flow cytometry specimens were examined and a complete