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Eighty-five tumors from 49 patients with transitional cell carcinoma were examined in a model for in vitro sensitivity using tumor explant reduction assay. Individual sensitivity patterns were obtained for each tumor tested. Explants were most frequently found to be sensitive to cis-platinum (49 per cent) and least frequently sensitive to thiotepa (20 per cent). Thirteen patients were studied on multiple sequential intervals, with resistance to specific agents noted to develop in 53 per cent of the patients. To date, a prospective cross-over study has been conducted on seven patients with 15 correlates. Overall, clinical correlation of this assay for both resistance and sensitivity is 93 per cent. We report a new assay for transitional cell carcinoma of the bladder that is adaptable to small specimen samples and provides adequate material for testing 73 per cent of the time.

Pararenal pseudocysts developed after an operation, after blunt and penetrating trauma or after contiguous disease processes in 16 patients. Nephrectomy was necessary in 8 cases. Although the duration of the pseudocyst and the extent of conduit injury did to an extent determine the fate of the kidney, the location of the encapsulated extravasate and its propensity for curtailment of urine formation appeared to be more significant factors. The cases were reviewed in light of the individualization in management required for the complex problems they present.

Our results with radioimmunoassay studies for parathyroid hormone performed during the last 6 years are compared retrospectively to results of the laboratory tests customarily secured when hyperparathyroidism is suspected. The results obtained in patients with known primary hyperparathyroidism and in patients with unconfirmed but presumptive hyperparathyroidism are compared to the results obtained from a group of normal controls. Despite the fact that certain discrepant results were noted in the earlier assay techniques the over-all results and, in particular, those of more recent years have been highly sensitive and reproducible corroboratives of the existence of primary hyperparathyroidism. About two-thirds of the patients with primary hyperparathyroidism will present to the urologist. All patients with calcium-containing stones should have at least 3 determinations of the serum calcium in screening for primary hyperparathyroidism. The radioimmunoassay for parathyroid hormone provides the most reliable confirmation. The patient with calculous disease, elevation of the immunoreactive parathyroid hormone level and hypercalcemia is virtually certain to have primary hyperparathyroidism.

An analysis of 16 children with the adrenogenital syndrome illustrates the diversity of the clinical and laboratory features of the disorder. The need for critical periodic evaluation of individual assessment of each child and the dosage of corticosteroids being used is emphasized.

We have reviewed 84 patients managed with cutaneous ureterostomy during the last 18 years. If at least 1 hypertrophied and dilated ureter is available cutaneous ureterostomy is a safe and effective diversion, with satisfactory late functional results. Stomal stenosis remains a continuing problem but usually is managed easily if present. Cutaneous ureterostomy should be used in selected patients until the ideal form of vesical substitution is achieved.

Fifty-seven patients with localized carcinoma of the prostate were treated with pelvic lymphadenectomy and a reduced 125iodine implant dosage, supplemented by a moderate dose of external beam radiotherapy to the whole pelvis delivered 4 to 6 weeks later. The incidence of pelvic nodal metastases was 28 per cent and the operative morbidity was 15 per cent. Late radiation sequelae developed in 18 patients, including 15 patients with radiation proctitis (29 per cent), among whom 2 (4.6 per cent) suffered rectal ulceration and required diverting colostomy. Followup has been 2 years or longer (median 33 months) in 26 patients, of whom 22 (85 per cent) are free of disease. Three patients are living with osseous metastases or local disease and there has been 1 death of prostatic carcinoma, for an absolute 2-year survival rate of 95 per cent. Of the 7 patients with poorly differentiated tumor and of the 8 patients with positive pelvic lymph nodes 5 and 6, respectively, remain free of disease after a minimum 2-year followup. Potency has been lost in 20 per cent and reduced significantly in 30 per cent of the patients followed 18 months or longer. Prostatic biopsies on 28 asymptomatic patients 12 to 30 months after completion of therapy showed no tumor in 21 (75 per cent).

A study of 84 patients with blunt renal trauma has revealed that expectant, non-operative management of the clinically stable patient with either minor or more severe injuries (excluding vascular pedicle trauma) gives satisfactory results and entails few subsequent complications. The nephrectomy rate with expectant management is markedly lower than that reported after an immediate operation. The salvage of functioning renal tissue appears to be commensurate with angiographic delineation of devascularized tissue and would seem to be comparable to that of patients afforded immediate surgical intervention, without the threat of loss of the renal unit that appears to be entailed by early operation.

The ABO subgroup A2 has been reported to be less reactive with the anti-A1 antibody naturally occurring in the serum of group O and B recipients and to occur in approximately 20% of group A individuals. Between March 1986 and February 1987, the Midwest Organ Bank (MOB) in Kansas City, screened all group A renal donors for the A2 subgroup. A total of 190 cadaverdonor kidneys were retrieved during this time, of which 68 were subgroup A1 and 16 were subgroup A2 (incidence of A2 = 19% of As and 8.5% of all donors). Of the subgroup A2 kidneys, 13 were transplanted into 9 group O and 4 group B recipients. One group O recipient received an HLA-identical A2 living-related graft. Recipients were not preselected or modified by splenectomy, plasmapheresis, or other means, and were treated with cyclosporine, steroids--and, in most cases, azathioprine, after transplantation. There was one hyperacute rejection and there were 5 acute cellular rejection episodes, 3 of which were reversed. One additional patient died at 2.5 months with a functioning graft. Including the successful living-related graft, 10 of 14 patients (71%) have functioning grafts, with a follow-up of 5 to 14 months, and a mean creatinine of 1.7 mg/dl. We find that the A2 subgroup represents a small but important minority of A donors, and that transplantation into non-A recipients can generally, but not universally, be safely accomplished. We recommend the screening of A donors for the A2 subgroup in both the cadaver-donor and living-related groups, and suggest that the utilization of A2 donors in non-A patients may contribute to the transplantation of group O and highly sensitized patients--and, in some cases, improve the degree of HLA matching.