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PURPOSE: Viral infections are a major cause of postoperative morbidity and mortality after renal transplantation. Although cytomegalovirus, Epstein-Barr virus, and polyoma virus infections are common, there have been only a few reports of adenovirus infections. MATERIALS AND METHODS: We report an unusual case of a patient with adenovirus-induced hemorrhagic cystitis (AHC). We also performed a comprehensive MEDLINE review to identify similar cases. We then compared the presentation, management, and outcome of all patients to identify patterns that may facilitate the diagnosis and management of AHC. RESULTS: Review of the literature revealed 36 other reported cases of AHC in renal transplant recipients. Thirty-six of the 37 cases occurred within 1 year of transplantation. These patients presented with fever, dysuria, hematuria, and graft dysfunction. Thirty-four received high-dose steroids for treatment of symptoms of acute rejection. Four patients received antiviral medications. The infection was self-limited with mean duration of symptoms being 20 days. In all cases, serum creatinine returned to baseline or near baseline levels with resolution of symptoms. CONCLUSIONS: Although uncommon, AHC usually presents within 1 year of renal transplantation with a consistent constellation of symptoms. The infection appears to be self-limited with full recovery in most patients within 4 weeks. The efficacy of antiviral medications could not be determined in this review.

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Following the rapid acceptance of laparoscopic cholecystectomy, a few adventurous surgeons "dared to boldly go where no one had gone before." They sought to achieve the same reduction in morbidity while accomplishing the same surgical goals. This paper will briefly review the current status of minimal access surgery for the solid organs of the abdomen. It will focus on the indications, risks, limitations, and on the balance between the trauma of access and the trauma of the procedure itself. As new techniques and equipment emerge and experience and data are accumulated, this balance may shift. Some of these procedures are in their infancy while others are rapidly becoming the new "Gold Standard".

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BACKGROUND: Fourteen cases of testicular sarcoma have been reported in the contemporary era. These included 7 cases of rhabdomyosarcoma, 2 spindle cell sarcoma, 2 osteosarcoma, 1 leiomyosarcoma, 1 fibrosarcoma, and 1 chondrosarcoma coma. METHODS: In this report, immunohistochemical stains, electron microscopy, and DNA flow cytometric analysis were performed on primary testicular sarcomas from three patients. RESULTS: The patients were age 47, 40, and 33 years. Each presented initially with a testicular mass. The tumors measured 4.8, 4.0, and 4.0 cm in greatest dimension. There was no associated germ cell elements nor elevated alpha-fetoprotein or beta-human chorionic gonadotropin. Case 1 was positive for actin, vimentin, and alpha-1-chymotrypsin. Case 2 was positive for vimentin but not desmin. Case 3 was positive for desmin and S-100. Smooth muscle differentiation was identified by electron microscopy. Flow cytometric analysis revealed DNA aneuploidy in all cases: 1.27, 1.29, and 1.71. The 3 patients were alive and well without recurrent disease at 7, 6, and 4 years after diagnosis. Inguinal orchiectomy was the initial treatment in all 17 patients, there was 1 death from metastatic disease and 2 patients with distant metastases. CONCLUSION: Primary testicular sarcoma is a rare indolent tumor with potential for distant metastases. Two cases of primary testicular leiomyosarcoma and one of unclassified sarcoma of the testis are reported.

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Although the frequency of renal carcinoma in tuberous sclerosis is lower than that in von Hippel-Lindau syndrome, it occurs bilaterally in 43 percent of patients at a median age of twenty-eight years. Concomitant hamartomas and hyperplastic cystic components may confound the histologic diagnosis of renal carcinoma in tuberous sclerosis.

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A 35-year-old white male presented with erectile dysfunction and areflexic bladder secondary to an intrathecal paraganglioma of the cauda equina. Erectile dysfunction has not been emphasized as a component of the cauda equina syndrome.

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Clinical correlations have been made with the applied anatomy of the infradiphragmatic urethra. The entire urethra was removed en bloc and the infradiaphragmatic urethra was carefully dissected with metallic sounds in situ. The urethra immediately distal to the urogenital diaphragm is devoid of any corporal tissue anteriorly and constitutes the 'bare area' tha can easily be injured during rigid urethral instrumentation.

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Prostatomy is a technique that may be utilized during radical prostatectomy and bowel substitution for end stage bladder disease to preserve the urethral segment, thereby facilitating subsequent anastomosis. Although it is not applicable to all stages of prostate cancer, the technique involves a progressive longitudinal incision in the anterior prostate from the bladder neck to the proximal apex of the prostate until the divergence of the lateral lobes is visualized, thereby allowing precise identification of the entire supra-diaphragmatic urethra. This permits maximal preservation of the urethra to improve the likelihood of continence.

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Amplification, rearrangement, or overexpression of the gene for the epidermal growth factor receptor (EGFR) occurs in certain types of human neoplasia. We investigated EGFR gene structure and measured EGFR mRNA levels in human renal tumor biopsies. Seventeen renal tumors [13 renal cell carcinomas (RCCs), two Wilms' tumors, one oncocytoma, and one metastatic ganglioneuroblastoma] and their corresponding normal kidney tissues were examined for EGFR gene structural integrity by Southern blot hybridization. Twelve of these tumors (including 11 RCCs) were examined for EGFR mRNA expression levels by RNA blot hybridization. The EGFR gene was rearranged in one of 13 (8%) of the RCC specimens examined and was highly amplified in the ganglioneuroblastoma. The overall frequency of EGFR gene structure alterations in this series of renal tumors was 12%. Nine of 11 RCC specimens (82%) exhibited markedly elevated EGFR mRNA levels (approximately 2- to 6-fold). In contrast, expression of the EGFR-related protooncogene HER-2 (erbB-2) was found to be decreased in 11 RCCs and one Wilms' tumor; HER-2 gene structure, however, appeared normal in all specimens. These results indicate that overexpression of EGFR mRNA, probably due to changes in gene regulation, and underexpression of HER-2 mRNA are characteristic features of human RCC.

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Leiomyosarcoma of the scrotum is a rare tumor that is best treated by wide local excision. Lymphatic metastasis is rare. To date a total of 14 cases have been reported.

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An unusual case of thrombosis in a left retroaortic renal vein is presented. Noninvasive radiologic diagnosis is reviewed.

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Prostatic abscess appears on computed tomography (CT) as multiple, well-demarcated fluid collections within the prostate gland and/or periprostatic tissues. Since prostatic abscess may not be differentiated from other prostatic disease on the basis of history and physical examination alone, CT can contribute significantly to establishing this diagnosis. Prostatic abscess can be an aggressive lesion within the pelvis and may rupture into the urethra, peritoneum, prevesical space, rectum, perineum, and ischiorectal fossa. By defining the extent of the disease, CT can guide selection of an optimal surgical drainage procedure. CT can be used effectively to monitor the treatment of prostatic abscess.

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