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Objectives To use 3-dimensional endovaginal ultrasound to describe the location and distribution of bulking agent after an uncomplicated transurethral injection. Methods Endovaginal ultrasound was performed in 24 treatment-naive patients immediately after bulking agent was injected. The distance between the center of the hyperechoic density of bulking agent and the urethrovesical junction (UVJ) was measured in the sagittal and axial views. This was calculated in percentile length of urethra. Also, the pattern of tracking of bulking agent was assessed if it is presented. Results After the 2 subjects were excluded because of the poor quality of images, 22 patients were included in this study. Eighteen (82%) subjects showed 2 sites of bulking agents, and mostly, they were located around 3- and 9-o'clock positions. The average distance of bulking agent from left UVJ was at 16.9% of the length of the urethra (6.2 mm; range, 0.5-17 mm) and at 25.5% of the length of the urethra (8.9 mm; range, 0-24.8 mm) in the right side. The average length of urethra was 36.7 mm. Eleven of the 22 subjects (50%) had both sides within upper one third of urethra. The difference in distance between the 2 sides was less than 10 mm in 12 of 22 patients (54%). Nine of the 22 patients (41%) had a significant spread of bulking agent mostly either into the bladder neck or toward the distal urethra. Conclusions Although the bulking agent is most often found at 3- and 9-o'clock positions as intended, the distance from the UVJ is highly variable after an uncomplicated office-based transurethral injection. The bulking material does not form the characteristic spheres in 41% of cases and tracks toward the bladder neck or the distal urethra.

Background The shortage of organs for transplantation is the most important factor limiting the number of transplants performed. Consequently, in recent years, criteria for considering a patient as a potential organ donor have been broadened. Methods From 1995 through 1996, we have retrieved organs from five donors who were brain dead because of bacterial meningitis. The causative microorganisms were Neisseria meningitidis in one patient, Streptococcus pneumoniae in three patients, and Escherichia coli in one patient. Fifteen organs were retrieved and transplanted into 16 recipients. All the donors and recipients received adequate antibiotic therapy. Results None of the recipients developed infectious complications caused by the meningeal pathogens. After a follow-up ranging from 4 to 30 months, 12 patients are alive with functioning grafts. The cause of death was noninfectious in the four patients who died. Conclusions Our study demonstrates that patients with brain death caused by bacterial meningitis due to meningococci, pneumococci, or E coli may be suitable organ donors. Transplantation of organs from such donors does not increase the risk of infection transmission to the recipient, provided that both donor and recipient had received adequate antibiotic therapy.

INTRODUCTION AND OBJECTIVES: To determine the applicability of the current prognostic models to predict disease recurrencefree survival (RFS) and cancer-specific survival (CSS) after nephrectomy in nonmetastatic renal cell carcinoma (RCC) in a Mediterranean Caucasian population. METHODS: We retrospectively reviewed the clinical and pathological variables of 305 patients treated with nephrectomy (partial or radical) for RCC. Three models were used to predict RFS (Kattan nomogram, Sorbellini model and Leibovich model), and three ones to predict CSS: the University of California at Los Angeles Integrated Staging System (UISS) model, the Stage, Size, Grade and Necrosis (SSIGN) model and the Karakiewicz nomogram. Survival was estimated using the Kaplan-Meier method. The predictive ability of the different scores was evaluated using the Harrell concordance index. RESULTS: With a median follow-up of 50.7 months, 41 patients (15.1%) died of RCC and in 54 (19.9%) the disease progressed. The 5-years CSS and RFS rates were 84.9% and 77.5%, respectively. Among the features included in the models, the Eastern Cooperative Oncology Group Performance Score (ECOG PS), pathological T (pT) stage, tumor size in surgical specimen, nuclear grade and pathological necrosis were significantly associated with RFS and CSS on univariate analysis. The ECOG PS, pT stage and nuclear grade also influenced in the multivariate analysis (Table 1). The c-indexes for RFS at 5 years were 0.626 for the Kattan nomogram and 0.696 for the Sorbellini model. The Leibovich nomogram presented c-indexes for RFS at 1, 3 and 5 years of 0.807, 0.728 and 0.721 respectively. The c-indexes for CSS were 0.774, 0.773, 0.772, 0.760 and 0.760 at 1, 2, 3, 4 and 5 years respectively for the UISS model, 0.831, 0.819 and 0.795 at 1, 3 and 5 years respectively for the SSIGN nomogram, and 0.752, 0.753 and 0.767 at 1, 2 and 5 years respectively for the Karakiewicz model. CONCLUSIONS: The current prognostic models are therefore validated in the Mediterranean Caucasian population with nonmetastatic RCC treated by surgery. The Leibovich nomogram was found to be most accurate to predict RFS, and SSIGN model to predict CSS. The most influential features in our population, both in RFS and CSS, were nuclear grade, ECOG PS and pT stage.