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The Benign Appearance of Wilms’ Tumor
194
ONCOLOGY AND CHEMOTHERAPY
Amer. J. Clin. Path., 81: 43-47 (Jan.) 1984 To prevent intrapartum infection of the neonate pregnant women with a history of genital herpes should be investigated at least weekly beginning at 32 to 34 weeks of gestation to determine the presence of active infection. If no clinical or laboratory evidence of the virus is present at the onset of labor a normal vaginal delivery may be permitted with a low risk of infection to the neonate. Otherwise, a cesarean section should be performed. A method for rapid detection of Herpes simplex virus using a combination of human fibroblast cell cultures with peroxidase-antiperoxidase staining after 18 to 24 hours of incubation was developed. The sensitivity of this method compared to viral isolation using primary rabbit kidney and human fibroblast cells was 88.4 per cent, with 20.7 per cent of clinical Herpes isolates detected by the human fibroblast cell peroxidase-antiperoxidase method before any signs of cytopathic effect of Herpes simplex virus were present. The specificity of the new procedure was 98.8 per cent and, over-all, 739 of 761 specimens (97.1 per cent) were identified correctly by the human fibroblast cell peroxidase-antiperoxidase method. This system can be used to confirm preliminary or questionable cytopathic effects. All of the specimens that exhibited possible cytopathic effects at 18 to 24 hours and from which the virus eventually was isolated also were positive by the human fibroblast cell peroxidaseantiperoxidase method. It seems that the new method can be helpful in the management of pregnant women with a history of genital herpes and in newborns suspected of having Herpes simplex virus infection. H. D. P. 2 figures, 2 tables, 19 references
Hepatitis A: Common and Costly J. S. MARR, Exxon Corporation, New York, New York
N. Y. State J. Med., 84: 3 (Jan.) 1984 In this editorial comment the author notes that viral hepatitis is, after gonorrhea, the second most frequently reported infectious disease in the country and that hepatitis A accounts for 45 per cent of the total cases of hepatitis. Food-borne outbreaks achieve much publicity but the majority of cases occur in children in day care centers and other closed settings. Although hepatitis A has no carrier state infants and children may be asymptomatic with the disease. Secondarily infected adults usually have great morbidity but mortality is rare. The author expresses his hope that an effective vaccine will result from current investigations using recombinant deoxyribonucleic acid technology. G. F. S. 5 references
Trimethoprim- Sulfamethoxazole- Related mia in a Patient With Renal Failure
Hypoglyce-
M. C. FRANKEL, B. R. LESLIE, F. L. SAX AND R. SOAVE, Rogosin Kidney Center and Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York N. Y. State J. Med., 84: 30-31 (Jan.) 1984 The authors report a case of hypoglycemia in a patient on dialysis treated with large doses of trimethoprim-sulfamethoxazole for a methicillin-resistant staphylococcal pyoarthrosis infection. Three tablets of trimethoprim (160 mg.) and sulfa-
methoxazole (800 mg.) were given 2 times daily. The patient experienced a grand mal seizure with a concomitant serum glucose of 25 mg./dl. 5 days after initiation of therapy. Hypoglycemia persisted until the dose of antibiotic was reduced drastically. The authors note that sulfamethoxazole bears a strong chemical resemblance to oral hypoglycemic sulfonylureas. Severe hypoglycemia associated with sulfamethoxazole therapy has not been reported previously. The history is consistent with sulfamethoxazole-stimulated pancreatic insulin release, resulting in symptomatic hypoglycemia with inappropriately high insulin levels. G. F. S. 10 references
ONCOLOGY AND CHEMOTHERAPY The Benign Appearance of Wilms' Tumor T. MAATMAN AND R. KAY, Department of Pediatric and Adolescent Medicine, Section of Pediatric Urology, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio Cleveland Clin. Quart., 50: 279-282 (Fall) 1983 Malignant renal neoplasms of childhood are uncommon. Wilms tumor is the most common of these lesions, with 450 cases reported per year in the United States. The correct diagnosis is essential to avoid progression of this fatal malignant disease and, conversely, to avoid inappropriate treatment with radiation and chemotherapy in children with benign disease. The authors present 2 cases in which all preoperative studies indicated benign renal disease, renal abscess and multilocular cysts. However, when an operation was performed to diagnose the intrarenal mass accurately malignant disease was found. Diagnosis of Wilms tumor usually is made on the basis of presenting symptoms, physical examination and radiological findings. Excretory urography (IVP) usually can detect a renal mass, and other studies can confirm and define the mass clearly. Ultrasound and/or computerized tomography can determine the consistency and help define the mass as solid or cystic. A cystic appearance usually suggests a multicystic or polycystic kidney but tumor must be considered in selected cases. Necrosis and hemorrhage may lead to a cystic appearance of the mass. In addition, tumors have been reported in multicystic kidneys. The necessity of arteriography in the diagnosis of Wilms tumor remains controversial. However, arteriography may be helpful in difficult diagnostic cases, with abnormal vascularity existing in 85 to 90 per cent of all Wilms tumors. The absence of pathologic vascularity does not rule out Wilms tumor as evidenced in 2 cases. Needle biopsy of selected renal masses has been used extensively in adults. The risk of disruption of the tumor with local implantation is rare. In children the procedure is used rarely, since the diagnosis usually is not in doubt and a needle biopsy potentially may contaminate the local area, requiring postoperative radiation. In addition, the finding of tumor cells would be confirmatory but a negative aspiration does not rule out the presence of a potentially malignant process. As in these 2 cases, if the diagnosis is in doubt surgical exploration may be necessary as a diagnostic and therapeutic step. The failure to diagnose the renal mass correctly in a child may allow fatal progression of the disease, and all diagnostic modalities from an IVP to an operation may be required and must be used in selected cases. G. P. M. 5 figures, 8 references
ONCOLOGY AND CHEMOTHERAPY
Amer. J. Clin. Path., 81: 43-47 (Jan.) 1984 To prevent intrapartum infection of the neonate pregnant women with a history of genital herpes should be investigated at least weekly beginning at 32 to 34 weeks of gestation to determine the presence of active infection. If no clinical or laboratory evidence of the virus is present at the onset of labor a normal vaginal delivery may be permitted with a low risk of infection to the neonate. Otherwise, a cesarean section should be performed. A method for rapid detection of Herpes simplex virus using a combination of human fibroblast cell cultures with peroxidase-antiperoxidase staining after 18 to 24 hours of incubation was developed. The sensitivity of this method compared to viral isolation using primary rabbit kidney and human fibroblast cells was 88.4 per cent, with 20.7 per cent of clinical Herpes isolates detected by the human fibroblast cell peroxidase-antiperoxidase method before any signs of cytopathic effect of Herpes simplex virus were present. The specificity of the new procedure was 98.8 per cent and, over-all, 739 of 761 specimens (97.1 per cent) were identified correctly by the human fibroblast cell peroxidase-antiperoxidase method. This system can be used to confirm preliminary or questionable cytopathic effects. All of the specimens that exhibited possible cytopathic effects at 18 to 24 hours and from which the virus eventually was isolated also were positive by the human fibroblast cell peroxidaseantiperoxidase method. It seems that the new method can be helpful in the management of pregnant women with a history of genital herpes and in newborns suspected of having Herpes simplex virus infection. H. D. P. 2 figures, 2 tables, 19 references
Hepatitis A: Common and Costly J. S. MARR, Exxon Corporation, New York, New York
N. Y. State J. Med., 84: 3 (Jan.) 1984 In this editorial comment the author notes that viral hepatitis is, after gonorrhea, the second most frequently reported infectious disease in the country and that hepatitis A accounts for 45 per cent of the total cases of hepatitis. Food-borne outbreaks achieve much publicity but the majority of cases occur in children in day care centers and other closed settings. Although hepatitis A has no carrier state infants and children may be asymptomatic with the disease. Secondarily infected adults usually have great morbidity but mortality is rare. The author expresses his hope that an effective vaccine will result from current investigations using recombinant deoxyribonucleic acid technology. G. F. S. 5 references
Trimethoprim- Sulfamethoxazole- Related mia in a Patient With Renal Failure
Hypoglyce-
M. C. FRANKEL, B. R. LESLIE, F. L. SAX AND R. SOAVE, Rogosin Kidney Center and Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York N. Y. State J. Med., 84: 30-31 (Jan.) 1984 The authors report a case of hypoglycemia in a patient on dialysis treated with large doses of trimethoprim-sulfamethoxazole for a methicillin-resistant staphylococcal pyoarthrosis infection. Three tablets of trimethoprim (160 mg.) and sulfa-
methoxazole (800 mg.) were given 2 times daily. The patient experienced a grand mal seizure with a concomitant serum glucose of 25 mg./dl. 5 days after initiation of therapy. Hypoglycemia persisted until the dose of antibiotic was reduced drastically. The authors note that sulfamethoxazole bears a strong chemical resemblance to oral hypoglycemic sulfonylureas. Severe hypoglycemia associated with sulfamethoxazole therapy has not been reported previously. The history is consistent with sulfamethoxazole-stimulated pancreatic insulin release, resulting in symptomatic hypoglycemia with inappropriately high insulin levels. G. F. S. 10 references
ONCOLOGY AND CHEMOTHERAPY The Benign Appearance of Wilms' Tumor T. MAATMAN AND R. KAY, Department of Pediatric and Adolescent Medicine, Section of Pediatric Urology, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio Cleveland Clin. Quart., 50: 279-282 (Fall) 1983 Malignant renal neoplasms of childhood are uncommon. Wilms tumor is the most common of these lesions, with 450 cases reported per year in the United States. The correct diagnosis is essential to avoid progression of this fatal malignant disease and, conversely, to avoid inappropriate treatment with radiation and chemotherapy in children with benign disease. The authors present 2 cases in which all preoperative studies indicated benign renal disease, renal abscess and multilocular cysts. However, when an operation was performed to diagnose the intrarenal mass accurately malignant disease was found. Diagnosis of Wilms tumor usually is made on the basis of presenting symptoms, physical examination and radiological findings. Excretory urography (IVP) usually can detect a renal mass, and other studies can confirm and define the mass clearly. Ultrasound and/or computerized tomography can determine the consistency and help define the mass as solid or cystic. A cystic appearance usually suggests a multicystic or polycystic kidney but tumor must be considered in selected cases. Necrosis and hemorrhage may lead to a cystic appearance of the mass. In addition, tumors have been reported in multicystic kidneys. The necessity of arteriography in the diagnosis of Wilms tumor remains controversial. However, arteriography may be helpful in difficult diagnostic cases, with abnormal vascularity existing in 85 to 90 per cent of all Wilms tumors. The absence of pathologic vascularity does not rule out Wilms tumor as evidenced in 2 cases. Needle biopsy of selected renal masses has been used extensively in adults. The risk of disruption of the tumor with local implantation is rare. In children the procedure is used rarely, since the diagnosis usually is not in doubt and a needle biopsy potentially may contaminate the local area, requiring postoperative radiation. In addition, the finding of tumor cells would be confirmatory but a negative aspiration does not rule out the presence of a potentially malignant process. As in these 2 cases, if the diagnosis is in doubt surgical exploration may be necessary as a diagnostic and therapeutic step. The failure to diagnose the renal mass correctly in a child may allow fatal progression of the disease, and all diagnostic modalities from an IVP to an operation may be required and must be used in selected cases. G. P. M. 5 figures, 8 references