Victor R. Jablokow

Secondary testicular tumors

Secondary testicular neoplasms are rare. Review of approximately 24,000 autopsies done at Hines Veterans Administration Hospital revealed 15 cases of metastatic involvement of the testes for an incidence of 0.06%. Histologic appearance of the metastatic tumors was identical to the primary sites and involved the testicle either as nodules or diffuse infiltration or both. By far, the most common primary site in our series was the lung; this spread to the testes in seven cases (47%). In contrast, review of the literature since the last extensive review39 revealed the prostate as the most common source. Although more frequent in the elderly, secondary testicular tumor from stomach and small bowel sources have a peak incidence at age 31, which places them in the age group of primary testicular neoplasms and should be considered in the differential diagnosis.

INverted papilloma of bladder

A case of inverted papilloma of the urinary bladder in a forty-six-year-old man is presented. The lesion is rare but may be easily misdiagnosed as transitional-cell carcinoma.

Case report 488

Address reprint requests to: Leo Ackerman, M.D., Nuclear Medicine Service (115), Hines VA Hospital, Hines, I1. 60141, USA to hospital because of progression of the pain. Physical examination revealed an ill-defined firm mass, about 8 cm in diameter over the lateral aspect of the left scapula. Motion of the shoulder was limited due to the pain. No evidence of fever, leukocytosis or abnormal blood chemical findings was elicited. A radiograph of the left shoulder showed soft tissue swelling and amorphous calcification at the

Case report 94.

This 76-year-old man was admitted initially to the Hines VA Hospital in July 1971 with a pruritic rash, constipation, nocturia and pain in the area of the left hip. The relevant biochemical studies included a serum calcium level of 12.5 mg per ml, a serum phosphorus of 5 mg per 100 ml, an alkaline phosphatase of 350 and on one occasion 1,240 International Units per 100 ml. The parathormone level was 12.4 microliter equivalents per ml, (normal 2.5 to 7.2 for normal calcium). The gastrointestinal tract absorption of labelled calcium was 77% to 85% (normal less than 74%). Because of the patients age and his reluctance to submit to surgery he was treated with oral phosphate. In the following two years the pain in the left hip increased in intensity. Roentgenograms of the left hip obtained in 1973 showed the characteristic changes of Paget disease, with a lyric lesion involving the lateral aspect of the left ilium (Fig. 1).

The Effect of Chronic Renal Insufficiency on cyclosporine Nephrotoxicity

Despite cyclosporines efficacy in preventing rejection, its use has been hampered by nephrotoxicity. Questions remain concerning its application in patients with decreased renal function. The purpose of this study was to 1) establish a reliable animal model with chronic renal insufficiency (CRI) to study cyclosporine (CyA) nephrotoxicity, and 2) compare the long-term (50 day) severity of CyA nephrotoxicity in CRI versus normal animals. Fischer 344 rats were divided into six groups (15 to 22 each). In three groups, CRI was induced by a 5/6th nephrectomy (three groups were sham operated). After three wks., daily i.p. injections of olive oil, CyA at five mg./kg., or CyA at 30 mg./kg. daily were administered. Serum and urine were collected at 10 day intervals for the determination of biochemical indices of renal function. Animals were sacrificed after 50 days of treatment and renal histology was evaluated by light and electron microscopy. Chronic CyA treatment was well tolerated by both intact and CRI rats, suggesting that this is a reliable model for long-term CyA toxicity studies. CyA decreased renal function at day 50 in both CRI and intact animals. CRI of mild to moderate degree had little effect on the biochemical and histological indices of CyA induced nephrotoxicity. CRI does appear to potentiate the metabolic toxicity that occurs after chronic treatment with high dose CyA.