J C Gingell

Fate of the testis following epididymitis: a clinical and ultrasound study.

The progress of 33 men suffering from acute epididymitis, the majority of whom were treated as hospital inpatients, was prospectively monitored in order to determine the incidence of complications, and to assess the prognostic implications of clinical and scrotal ultrasound features found at initial presentation. Serious testicular complications resulting in frank infarction, suppurative necrosis and late atrophy developed in 39%. Three factors were shown to have significant discriminant value in predicting an adverse outcome: severe degree of inflammation with induration of the spermatic cord; the presence of a coexistent bacterial urinary infection; and a uniformly reduced testicular echo pattern on the affected side as visualized on ultrasound. A more aggressive approach in addition to medical measures appears to be indicated in these patients. The rationale of early surgical decompression by epididymotomy and spermatic fasciotomy is discussed. Scrotal ultrasound should be considered as a routine investigation in the management of epididymitis.

Role of Franzen needle aspiration biopsy in carcinoma of the prostate.

A retrospective study is reported of all Franzen fine-needle aspiration cytology undertaken at Southmead Hospital between January 1978 and December 1981. A total of 1043 aspirates were examined from 753 patients. The diagnosis of carcinoma of the prostate was missed in 2 patients. Twenty-one patients with cytologicallyproven carcinoma in histologically-benign prostates were detected, and the role of the Franzen needle in the diagnosis of early prostatic cancer is discussed. Of the 218 patients proceeding to prostatectomy, there were 91 patients with carcinoma and in 65 (72%) the cytological and histological grading was identical. A significant disparity occurred in 8 cases and the reasons are discussed.

Magnetic resonance imaging of spinal metastases.

Sixty-six patients with spinal metastatic disease secondary to urological malignancy underwent magnetic resonance imaging. Twenty-eight patients had clinical evidence of spinal cord compression. MRI demonstrated metastatic cord compression in 16 cases, a benign cause in two cases, nerve root involvement in five cases. In seven patients MRI demonstrated spinal metastases which were not visible on plain radiographs and isotope bone scans. Nine patients had metastatic deposits involving the cauda equina and in a further 22 patients spinal metastases were an incidental finding during MRI for staging of the primary tumour. MRI is a sensitive method of imaging spinal metastases and provides a noninvasive means of assessing patients with spinal cord compression.

Intracorporeal Papaverine Injection in Androgen Deprived Men

The intracorporeal injection of papaverine (ICP) is now a well recognized therapeutic option in the management of impotence. The current treatment of advanced prostatic carcinoma causes erectile failure. Although intracorporeal papaverine can induce erections in these men, libido is also reduced so that the role of ICP is limited to those men complying with the wishes of a highly motivated partner.

Book Review: Interstitial CystitisInterstitial CystitisHanno, StaskinKrane and Wein, eds £55.00 ISBN 3-540-19598-X London: Springer, 1990

Travels of a Surgeon A Eyre-Brook 198 pp £12.95 ISBN 0-948265-29-9 Bristol: White Tree Books, 1990 This book, by one of the most distinguished British orthopaedic surgeons of his generation, is basically an autobiography. But it is much more than that. From the time of his surgical training until, at the age of nearly 80, ill health compelled him to give it up, travel was one of Arthur Eyre-Brooks great interests. And wherever he went he concerned himself not only with the surgical needs of his hosts but also with the history, geography, religion and politics of their country. The book, written after his final retirement from travel, describes his experiences in America, Asia and Africa, and does so in a simple, clear and readable way. As with most books of travel, the most enjoyable chapters are those dealing with countries which the reader himself knows. Here it is often surprising to find how much more he has noticed than one did oneself. But the writing holds your attention even when dealing with somewhere entirely new. Perhaps the greatest value of the book is that it shows what a wealth offascinating experience lies in wait for the surgeon who. retiring from the NHS, is prepared to put his skill at the service of Third World countries. Orthopaedic surgeons are fortunate in that, in World Orthopaedic Concern. they have an organization which can direct their efforts. Amid all his other distinctions it will surely be for his work for WOCthat Arthur Eyre-Brook will be most widely remembered. His book is a stimulating account of it. P R WRIGHT Honorary Consultant Orthopaedic Surgeon Canterbury and Thanet Health District